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This paper is the third in a series of narrative reviews challenging core concepts in oral health research and practice. Our series started with a framework for Inclusion Oral Health. Our second review explored one component of this framework, looking at how intersectionality adds important complexity to oral public health. This current manuscript drills into a second component of Inclusion Oral Health, exploring how labels can lead to 'othering' thereby misrepresenting populations and (re)producing harms. Specifically, we address a common oral public health label: vulnerable populations. This term is commonly used descriptively: an adjective (vulnerable) is used to modify a noun (population). What this descriptor conceals is the 'how,' 'why,' and 'therefore' that leads to and from vulnerability: How and why is a population made vulnerable; to what are they vulnerable; what makes them 'at risk,' and to what are they 'at risk'? In concealing these questions, we argue our conventional approach unwittingly does harm. Vulnerability is a term that implies a population has inherent characteristics that make them vulnerable; further, it casts populations as discrete, homogenous entities, thereby misrepresenting the complexities that people live. In so doing, this label can eclipse the strengths, agency and power of individuals and populations to care for themselves and each other. Regarding oral public health, the convention of vulnerability averts our research gaze away from social processes that produce vulnerability to instead focus on the downstream product, the vulnerable population. This paper theorizes vulnerability for oral public health, critically engaging its production and reproduction. Drawing from critical public health literature and disability studies, we advance a critique of vulnerability to make explicit hidden assumptions and their harmful outcomes. We propose solutions for research and practice, including co‐engagement and co‐production with peoples who have been vulnerabilized. In so doing, this paper moves forward the potential for oral public health to advance research and practice that engages complexity in our work with vulnerabilized populations. [ABSTRACT FROM AUTHOR]

Aims: To share the need for agreement in terminology around how people are supported to receive dental care. Method: In this position paper, we make the case for a shift in behavior support in dentistry from an art to a science. Results: We outline why we need agreement on the definition of behavior support across dentistry, agreement on underlying theory, aims and values, and why we need agreement on terms for specific techniques. Conclusions: We share how patients and dental teams can benefit through better science, education and practice of dental behaviour support. [ABSTRACT FROM AUTHOR]

Background: The oral health promotion sessions for young children and parents in a clinical setting pose challenges to the dental team. Aim: To apply PaeD‐TrICS (Paediatric dental triadic interaction coding scheme) to investigate the interaction of child, parent and dental nurse and determine the effect of nurse and parental behaviours on child participation within an oral health promotion session. Method: A video observational study was applied. The sample consisted of a dental nurse and 22 children aged 2‐5 years in a general dental practice in Scotland. Behaviours were catalogued with time stamps using PaeD‐TrICS. Analysis of behavioural sequences with child participation as the dependent variable was conducted using multilevel modelling. Results: Children varied significantly in their participation rate. The statistical model explained 28% of the variance. The older the child and longer consultations significantly increased child participation. Both nurse and parental behaviour had immediate influence on child participation. Parental facilitation had a strong moderating effect on the influence of the nurse on child participation. Conclusions: Child participation was dependent on nurse and parent encouragement signalling an important triadic communication process. The coding scheme and analysis illustrates an important tool to investigate these advisory sessions designed for delivering tailored messages to young children and parents. Patient or Public Contribution: The dental staff, child patients and their parents were involved closely in the conduct and procedures of the present study. [ABSTRACT FROM AUTHOR]

This paper is the second of two reviews that seek to stimulate debate on new and neglected avenues in oral health research. The first commissioned narrative review, "Inclusion oral health: Advancing a theoretical framework for policy, research and practice", published in February 2020, explored social exclusion, othering and intersectionality. In it, we argued that people who experience social exclusion face a "triple threat": they are separated from mainstream society, stigmatized by the dental profession, and severed from wider health and social care systems because of the disconnection between oral health and general health. We proposed a definition of inclusion oral health and a theoretical framework to advance the policy, research and practice agenda. This second review delves further into the concept of intersectionality, arguing that individuals who are socially excluded experience multiple forms of discrimination, stigma and disadvantage that reflect intersecting social identities. We first provide a theoretical and historical overview of intersectionality, rooted in Black feminist ideologies in the United States. Our working definition of intersectionality, requiring the simultaneous appreciation of multiple social identities, an examination of power and inequality, and a recognition of changing social contexts, then sets the scene for examining existing applications of intersectionality in oral health research. A critique of the sparse application of intersectionality in oral health research highlights missed opportunities and shortcomings related to paradigmatic and epistemological differences, a lack of robust theoretically engaged quantitative and mixed methods research, and a failure to sufficiently consider power from an intersectionality perspective. The final section proposes a framework to guide future oral health research that embraces an intersectionality agenda consisting of descriptive research to deepen our understanding of intersectionality, and transformative research to tackle social injustice and inequities through participatory research and co‐production. [ABSTRACT FROM AUTHOR]

Objectives: The FiCTION trial compared co‐primary outcomes (dental pain and/or infection) and secondary outcomes (child oral health‐related quality of life [COHRQOL], child dental anxiety, cost‐effectiveness, caries development/progression and acceptability) across three treatment strategies (Conventional with Prevention [C + P]; Biological with Prevention [B + P]; Prevention Alone [PA]) for managing caries in children in primary care. COHRQOL and child dental anxiety experiences are reported upon here. Methods: A multi‐centre, 3‐arm, parallel‐group, unblinded patient‐randomized controlled trial of 3‐ to 7‐year‐olds treated under NHS contracts was conducted in 72 general dental practices in England, Wales and Scotland. Child participants (with at least one primary molar with dentinal caries) were randomized (1:1:1) to one of three treatment arms with the intention of being managed according to allocated arm for 3 years (minimum 23 months). Randomization was via a centrally administered system using random permuted blocks of variable length. At baseline and final visit, accompanying parents/caregivers completed a parental questionnaire including COHRQOL (16 item P‐CPQ‐16), and at every visit, child‐ and parental‐questionnaire‐based data were collected for child‐based dental trait and state anxiety. Statistical analyses were conducted on complete cases from the modified intention‐to‐treat (mITT) analysis set. Results: A total of 1144 children were randomized (C + P: 386; B + P: 381; PA: 377). The mITT analysis set included the 1058 children who attended at least one study visit (C + P: 352; B + P: 352; PA: 354). Median follow‐up was 33.8 months (IQR: 23.8, 36.7). The P‐CPQ‐16 overall score could be calculated after simple imputation at both baseline and final visit for 560 children (C + P: 189; B + P: 189; PA: 182). There was no evidence of a difference in the estimated adjusted mean P‐CPQ‐16 at the final visit which was, on average, 0.3 points higher (97.5% CI: −1.1 to 1.6) in B + P than C + P and 0.2 points higher, on average, (97.5% CI: −1.2 to 1.5) in PA than for C + P. Child dental trait anxiety and child dental state anxiety, measured at every treatment visit, showed no evidence of any statistically or clinically significant difference between arms in adjusted mean scores averaged over all follow‐up visits. Conclusions: The differences noted in COHRQOL and child‐based dental trait and dental state anxiety measures across three treatment strategies for managing dental caries in primary teeth were small, and not considered to be clinically meaningful. The findings highlight the importance of including all three strategies in a clinician's armamentarium, to manage childhood caries throughout the young child's life and achieve positive experiences of dental care. [ABSTRACT FROM AUTHOR]

Objective: To test a theoretical mediation model and investigate whether drug use and/or dental anxiety act as mediating factors between depression and dental decay experience among prisoners. Method: A cross‐sectional survey was conducted on a convenience sample of 300 prisoners across three prison establishments in Scotland. Depression and dental anxiety were measured using the Centre for Epidemiological Studies Depression Scale and the Modified Dental Anxiety Scale, respectively. Drug use was assessed using three yes (scoring 1)/ no (scoring 0) questions: 'ever taken (illegal) drugs', 'injecting drugs' and 'ever participated in a rehabilitation programme'. Participants had an oral examination to determine dental caries experience (missing [MT] and untreated decay [D3cvT]) in all four quadrants. Latent variable path analysis was conducted to test the mediation model. Results: A total of 342 prisoners participated, of which 298 yielded a complete data set. Depression was associated with missing teeth and untreated decay (D3T) through an indirect pathway (Total standardized indirect effects = 0.11, P <.01) via drug use and dental anxiety (X2 [71] = 89.8, P =.07; Root Mean Square Error of Approximation: 0.03; Comparative Fit Index: 0.994 and Tucker‐Lewis index: 0.992). Twenty‐two percent of the variance in untreated decay and missing teeth was explained by both drug use and dental anxiety; however, the strongest predictor was drug use (total standardized direct effects = 0.45, P <.001). Conclusion: A relatively simple model to assist understanding dental decay experience of people in prison has been proposed. The data collected were consistent with our specified model. Drug use acted as the primary mediator and dental anxiety as a secondary mediator between depression and dental decay experience. Given the co‐morbidity between mental health and drug use and dental decay experience, an integrated or shared approach is proposed. We recommend that future research should concentrate on building a firmer picture by replicating and extending the framework presented. [ABSTRACT FROM AUTHOR]

Objectives: The aim was to confirm the factor structure of Modified Dental Anxiety Scale (MDAS) and to investigate whether the association of these factors with general anxiety and depression varied across gender. Methods: The FinnBrain Birth Cohort Study (www.finnbrain.fi) data from the first collection point at gestational week 14 were used. Of the invited participants (n = 5790), 3808 (66%) expectant mothers and 2623 fathers or other partners of the mother agreed to participate, and 3095 (81.3%) mothers and 2011 (76.7%) fathers returned the self‐report questionnaire. Dental anxiety was measured with the MDAS, general anxiety symptoms with Symptom Checklist‐90 (anxiety subscale) and depressive symptoms with the Edinburgh Postnatal Depression Scale. Multiple group confirmatory factor analysis (MGCFA) was conducted to test the equivalence of the factor structure and multiple group SEM (MGSEM) to test the configural invariance (unconstrained model) and metric invariance (structural weights model), across genders. Results: Of those consenting, 3022 (98%) women and 1935 (96%) men answered the MDAS. The MGCFA indicated good convergent validity for the two‐factor model for MDAS, but somewhat low discriminant validity (factors demonstrated 72% shared variance). The MDAS items loaded clearly higher for the assigned factor than to the other factor (differences in loadings >0.2), indicating that the 2‐factor model has merit. According to the final MGSEM model, anxiety symptoms were directly related to anticipatory dental anxiety, but not to treatment‐related dental anxiety. Conclusions: When assessing dental anxiety with MDAS, considering also its two factors may help clinicians in understanding the nature of patient's dental anxiety. [ABSTRACT FROM AUTHOR]

In response to headlines about the oral health of persons experiencing social exclusion resonating in high‐income countries, and research demonstrating the need for urgent action, a symposium entitled 'International Perspectives on Socially Inclusive Dentistry: A Call to Action' was organized for the IADR International Meeting of 2018. The aim of the symposium was to initiate an international dialogue on barriers to care, multidisciplinary action and examples of best practice for service delivery for people experiencing social exclusion; in other words, to develop the idea of inclusion oral health. Through our international exchange, what emerged was an awareness of a lack of professional consensus: What exactly is inclusion oral health? A theoretical framework to push forward the policy, research and practice agenda was clearly needed. This paper advances such a framework. Over the decades, dentistry has forged an approach to service delivery mainly through a business, demand‐led model. While oral health continues to improve globally, an important consequence of this approach is that it compounds the social exclusion that many people are already experiencing because of a constellation of economic, political, cultural and individual factors. Thus, many people are simply not getting the dental care they need. In contrast, drawing on the theoretical literature on social exclusion, intersectionality and othering, we suggest that dentistry could act as an agent for social inclusion as a more responsive, all‐encompassing form of oral health care and delivery. This paper advances a theoretical framework for inclusion oral health, and an action plan to show how inclusion oral health may become one solution in an armamentarium to tackle the global phenomena of oral health inequities. [ABSTRACT FROM AUTHOR]

Aim: To examine the perceived importance and knowledge of the dental students' in their treatment of dental anxiety according to their year of study and to find out patients' perceived importance of the dental students' knowledge of dental anxiety according to their level on dental fear. Methods: Dental students (N = 219) at the University of Turku and non‐probability convenience sample of 100 of patients attending the Dental Teaching Clinic were given questionnaires with multiple choice and open‐ended questions. Students were categorised into three groups according to the year of study (1‐3, 4, 5). Patients were categorised into three groups using the established cut points for Modified Dental Anxiety Scale (no fear = 5‐9, low fear = 10‐18, high fear = 19‐25). The differences between groups were evaluated using cross‐tabulations, chi squared and Fisher's exact tests. The open‐ended questions were subjected to content analysis. Results: Students' perceived importance of dental anxiety did not differ between three groups. Students with greater undergraduate education and clinical experience were more likely to have excellent or quite good knowledge (P < .001). Patients' perceived importance of dental students' knowledge of dental anxiety was greater in patients with high level of fear. The overlapping category that emerged from the open‐ended question analysis was communication skills. This appeared to be important for patients with dental anxiety and for dental students in their management of dental anxiety. Conclusion: Clinical communication skills should be part of dental anxiety management teaching. Dental students should be able to gain sufficient knowledge and skills in treating dental anxiety before graduating. [ABSTRACT FROM AUTHOR]

Summary: Aim: To test the psychometric properties of an Arabic version of the Child Fear Survey Schedule‐Dental Subscale (CFSS‐DS) a using confirmatory factor analysis. Methods: Two convenience samples were obtained: Sample [1]: 600 boys (33%) and girls attending 4 public schools in Onizah and Sample [2] 800 girls attending 8 public schools in Buridah. The questionnaire asked the participant's age, gender, and completion of the CFSS‐DS. The data were subjected to exploratory factor analysis (EFA), parallel factor analysis, Cronbach's alpha, confirmatory factor analysis (CFA), and goodness of fit statistics. Results: A total of 513 children in Sample [1] and 503 children in Sample [2] participated giving a valid response rate of 86% and 67%, respectively. From the EFA, 3 factors were identified and confirmed statistically using parallel factor analysis. The internal consistency of the 3 factors, Dental Fear Subscale (0.86), Hospital Fear Subscale (0.77), and Stranger Fear Subscale (0.71), was good. The CFA showed that the current EFA model was an equivalent fit to the El Housseiny et al (BMC Oral Health 2016;16:49). model; however, the solution using El Housseiny et al's structure was distorted. Conclusions: A 3‐factor structure with acceptable reliability exists for this Arabic version of the CFSS‐DS, confirmed by a CFA using an additional data set. [ABSTRACT FROM AUTHOR]

Introduction: Communication skills are an integral component of dental undergraduate education. Due to the complex nature of these skills, didactic teaching methods used in other educational contexts can be limited. Interactive and participative methods rooted in modern adult learning theories, such as Forum Theatre, may be more effective in the teaching of communication skills. Aim: To explore the usefulness of Forum Theatre in teaching clinical undergraduate dental students how to break bad news to their patients. Methods: A purposive sample of 4th‐year undergraduate dental students was invited to participate. An evaluation questionnaire was given to the students and collected after the Forum Theatre interactive session. Participants were asked to provide self‐reported accounts on the most and least useful parts of the session, as well as the most important learning outcome. Usefulness of the session in clinical work, increasing confidence and ability in breaking bad news, were evaluated via a 5‐point Likert‐scale type question. Qualitative data were analysed using Framework Analysis to explore the themes found in the open‐text component. Descriptive statistics were used to analyse the Likert‐scale items. Results: One hundred and fifteen completed questionnaires were collected from the 2015 and 2016 classes. Most students gave the Forum Theatre session a rating of 3 or above on a 5‐point Likert scale; indicating that they found it useful. Qualitative results also showed that most participants liked the teaching session thanks to its interactive nature, the use of actors and the input of the facilitators. The majority of students showed preference towards smaller groups which give everyone equal opportunity to participate without unnecessary repetition. Conclusion: The results seem to confirm previous findings. Students rated their learning experience involving Forum Theatre favourably. Smaller groups and trained facilitators are required for the success of this teaching method. Further research is needed to assess the long‐term educational benefits of Forum Theatre. [ABSTRACT FROM AUTHOR]

Objective To evaluate the contribution of dental anxiety to social gradients in different oral health outcomes and whether social gradients in oral health persist once dental anxiety is removed from the population examined. Methods Data from 9035 British adults were analysed. Participants' socioeconomic position ( SEP) was measured through education and household income. Dental anxiety was measured with the Modified Dental Anxiety Scale. Poor subjective oral health, oral impacts on quality of life and edentulism among all adults and the number of teeth, the number of decayed, missing and filled surfaces (DMFS) and sextants with pocketing among dentate adults were the oral health outcomes. The contribution of dental anxiety to absolute and relative social inequalities in each oral health outcome (measured with the Slope and Relative Index of Inequality [ SII and RII], respectively) was estimated from regression models without and with adjustment for dental anxiety and quantified with the percentage attenuation. Interactions between each SEP indicator and dental anxiety were used to test what would happen if dental anxiety were removed from the whole population. Results The largest contribution of dental anxiety to explaining oral health inequalities was found for education gradients in perceived outcomes (11%-13%), but dental anxiety explained <4% of social gradients in edentulism. Among dentate adults, dental anxiety accounted for <5% and <7% of education and income gradients, respectively. Only four of the 24 interactions tested were statistically significant. Hence, the education- and income-based SII and RII for oral impacts were nonsignificant among anxiety-free adults but were significant at higher levels of dental anxiety. Conclusions Little support was found for the role of dental anxiety in explaining social inequalities in various perceived and clinical oral health measures. Oral health inequalities were found among both nondentally anxious and anxious participants. [ABSTRACT FROM AUTHOR]

Objective: To explore qualitatively, using a grounded theory approach, homeless people's awareness of their oral health needs and how they access dental services using a deconstruction-reconstruction formulation, and provide recommendations for service designers and dental professionals who work with people experiencing homelessness. Methods: A qualitative study using grounded theory methodology was conducted. A purposive sample of homeless people was recruited from health facilities and organizations serving homeless populations in four Scottish cities and towns. Participants were interviewed about their oral health within the wider context of their experiences of homelessness. Initial research questions were open and focused on social processes such as oral health practices and interaction with dental services. Data collection and analysis were carried out simultaneously and iteratively, with emerging findings informing subsequent cycles. Data analysis was guided by Glaser and Strauss's grounded theory methodology and involved constant comparison, coding of transcripts and detailed memo-writing. Results: Thirty-four homeless people took part. Participant experiences were conceptualized as a journey into and through the stages of homelessness, towards 'reclaiming life'. Oral health experiences were mapped as a parallel 3-stage journey from the deconstruction of self-care, to the construction and maintenance of the neglected dentine, and finally to the reclamation of oral health resulting in a reconstructed functioning dentition. Conclusions: This qualitative exploration using a deconstruction-reconstruction formulation has added to the understanding of homeless people's oral health awareness and dental treatment access while permitting an examination of the wider socioeconomic and psychosocial issues that disrupt their intentions to attend for treatment. These findings provide service designers and dental professionals with recommendations for the provision of responsive, acceptable and appropriate dental health services for those experiencing homelessness. [ABSTRACT FROM AUTHOR]

Background Health literacy has been conceptualised to explain how health information facilitates the maintenance of health. What are the clinical implications of children's health literacy? Children have language skills, numeracy, and reading skills that are in a state of flux - how do they decipher and encode adult health messages to make them their own? Aim To explore children's health and oral health literacy and discover what processes they use to convert adult health messages into useable information. Methods Observations and descriptive case study approach. Results A theoretical and developmental perspective on children's health and oral health literacy, based upon the ability of the adult to provide a health message with a common shared element, is proposed. It is this common element that the child uses to make adult words understandable and to generate health action. Conclusions Children's health and oral health literacy development is achieved, through, a torturous path, supported by the way adults provide health messages to children. Taking time to identify this common element, helping children to encode and reflect upon the health message will help children convert adult oral health messages into their own oral health practices, and support their emerging health and oral health literacy. [ABSTRACT FROM AUTHOR]

Objectives To identify the job resource beliefs of preregistration dental nurses and subsequently investigate their relationship with work engagement, personal accomplishment and intention to leave amongst this occupational group in Scotland. Methods A cross-sectional survey design was used. The Utrecht Work Engagement Scale, Personal accomplishment (a subscale of Maslach Burnout Inventory) and author-developed questions for job resource beliefs and intention to leave were the measuring instruments used. Results Two hundred and thirty-one dental nurses participated (82% response rate). Mean age was 25 and mean job tenure was 17.5 months. The job resource belief most valued was 'good working relationship'. A multiple mediated path analytical model was explored. Work engagement adjusted for job resource beliefs was very strongly negatively associated with intention to leave (−0.93). There was an indirect relationship between job resource beliefs and intention to leave (−0.28) mediated via work engagement and personal accomplishment. Conclusions Dental nurses under training held job resource beliefs about their profession that were associated with work engagement, personal accomplishment and their stability of remaining in the job. [ABSTRACT FROM AUTHOR]

Objectives To assess the validity and reliability of a Parental Dental Concerns Scale ( PDCS) to identify parents unable to access preventive dental care for their children. Methods Two studies were conducted. In Study One, a purposive convenience sample of 399 Scottish parents answered questions on going to the dentist, family life and demographics. Parents were retested eight weeks later. In Study Two, 574 Scottish parents participating in a preventive oral health programme were posted the same questionnaire. Information on child dental attendance was gained from dental records. Data were analysed using exploratory ( EFA) and confirmatory ( CFA) factor analysis. Internal consistency and test-retest correlations provided reliability estimates. Validity was assessed with confirmatory factor analysis, correlations and independent t-tests. Results EFA indicated that the PDCS had a four factor structure, supported by a subsequent CFA. The PDCS and its four subscales had good internal consistency, concurrent validity and test-retest reliability. Further work is required to confirm the scale's predictive validity in discriminating between children and parents who did and did not attend the dental practice. Conclusions The PDCS is a reliable scale, which demonstrates good construct validity. Further testing is required to confirm its predictive validity. [ABSTRACT FROM AUTHOR]

Objectives Obesity and dental caries have become increasingly prevalent challenges to public health. Research results into the relationship between obesity and dental caries in children have been mixed and inconclusive. The aim of this review and meta-analysis was to provide evidence to quantify the relationship between obesity and dental caries in children using a systematic approach. Methods A systematic search for papers between 1980 and 2010 addressing childhood obesity and dental caries was conducted and a random effects model meta-analysis applied. Results Fourteen papers met the selection criteria. Overall, a significant relationship between childhood obesity and dental caries (effect size = 0.104, P = 0.049) was found. When analysed by dentition type (primary versus permanent), there was a nonsignificant association of obesity and dental caries in permanent and primary dentitions, yet on accounting only for standardized definitions for assessment of child obesity using body mass index, a strong significant relationship was evident in children with permanent dentitions. Moderating for study country of origin (newly 'industrialized' versus industrialized) showed a significant relationship between obesity and dental caries in children from industrialized but not newly industrialized countries. Cofactors such as age and socioeconomic class were significant moderators. Conclusions Future analysis should investigate these confounding variables, helping shape the future of obesity management programmes and oral health interventions, through determining common risk factors. [ABSTRACT FROM AUTHOR]

A study is presented which examined work-related stress among dental health professionals in the Western Health and Social Services Board (WHSSB) area in Northern Ireland. The researchers measured burnout, job demands, work engagements and resources, and general psychological health, using questionnaires and statistical analysis. It is suggested that dental health professionals and other dental staff (DCP) are in need of help to prevent burnout.

International Journal of Paediatric Dentistry 2010; 20: 83–101 Background. The relationship between parental and child dental fear has been studied for over a century. During this time, the concept of dental fear as well as methodological approaches to studying dental fear in children have evolved considerably. Aim. To provide an overview of the published empirical evidence on the link between parental and child dental fear. Design. A structured literature review and meta-analysis. Results. Forty-three experimental studies from across the six continents were included in the review. The studies ranged widely with respect to research design, methods used, age of children included, and the reported link between parental and child dental fear. The majority of studies confirmed a relationship between parental and child dental fear. This relationship is most evident in children aged 8 and under. A meta-analysis of the available data also confirmed an association between parental and child dental fear. Conclusion. The narrative synthesis as well as the meta-analysis demonstrate a significant relationship between parental and child dental fear, particularly in children 8 years and younger. [ABSTRACT FROM AUTHOR]

Esa R, Savithri V, Humphris G, Freeman R. The relationship between dental anxiety and dental decay experience in antenatal mothers. Eur J Oral Sci 2010; 118: 59–65. © 2010 The Authors. Journal compilation© 2010 Eur J Oral Sci The aim of this study was to investigate the relationship between dental anxiety and dental decay experience among antenatal mothers attending Maternal and Child Health clinics in Malaysia. A cross-sectional study was conducted on a consecutive sample of 407 antenatal mothers in Seremban, Malaysia. The questionnaire consisted of participants’ demographic profile and the Dental Fear Survey. The D3cvMFS was employed as the outcome measure and was assessed by a single examiner (intraclass correlation = 0.98). A structural equation model was designed to inspect the relationship between dental anxiety and dental decay experience. The mean Dental Fear Survey score for all participants was 35.1 [95% confidence interval (34.0, 36.3)]. The mean D3cvMFS score was 10.8 [95% confidence interval (9.5, 12.1)]. Participants from low socio-economic status groups had significantly higher D3cvMFS counts than those from high socio-economic status groups. The path model with dental anxiety and socio-economic status as predictors of D3cvMFS showed satisfactory fit. The correlation between dental anxiety and dental decay experience was 0.30 (standardized estimate), indicating a positive association. Socio-economic status was also statistically significantly associated with the D3cvMFS count (β = 0.19). This study presented robust evidence for the significant relationship between dental anxiety and dental decay experience in antenatal mothers. [ABSTRACT FROM AUTHOR]

Background. Despite improvements over the past two decades, caries and its treatment remain a problem for Scottish children. Aim. To investigate how the reported childhood dental care experiences of a group of Scottish parents impacted upon the dental treatment they accessed for their children. Study design. In-depth, semi-structured interviews were conducted with 19 parents of varied age and social background whose children were referred to Dundee Dental Hospital for the assessment of dental extractions. Parents were encouraged to discuss their own and their child’s experiences of dental care. The interview data were systematically coded using key theme headings, and summary charts constructed to facilitate the analysis. Results. A sense of ‘uneasiness’ pervaded the parents’ comments and perceptions of the dental care provided for their children. This was conceptualized as parents ‘remembering in words’ and ‘repeating through actions’ their own childhood dental experiences. They remembered and repeated their childhood experiences by delaying dental treatment for themselves and their children. Conclusions. Acknowledging the influence of parental dental experience would help ensure that parents of young children access routine care for their children and themselves. [ABSTRACT FROM AUTHOR]

Aim. The aim of this study was to assess the effectiveness of the passivity to activity through live symbolic (PALS) after treatment modelling intervention to reduce child dental anxiety. Methods. A convenience sample of consecutive 5- to 10-year-old dental patients were randomly assigned to intervention or control groups. Self-reported child dental anxiety was assessed at the start of each visit. At the end of each visit, children in the intervention group were introduced to a glove puppet, which acted as the PALS model. The intervention group children re-enacted the treatment they had just received on the puppet's teeth. At the end of each visit, the control children received motivational rewards only. The change in dental anxiety scores was examined by t-tests and analysis of covariance. Results. The final analysis included 27 intervention children and 26 control children. For the intervention group, there were no statistically significant changes in dental anxiety over a course of treatment, between first and second preventive visits, between first and second invasive treatment visits, or between first attendance and subsequent recall attendance. For the control group, a statistically significant decrease in dental anxiety was observed between the first and second invasive dental treatment visits. Conclusion. The PALS after treatment modelling intervention was ineffective in reducing child dental anxiety. [ABSTRACT FROM AUTHOR]

Background: Nursing caries is considered to be problematic by dental health professionals. In their zealousness to solve the nursing caries problem dental health professionals forgot to ask the question: ‘Why do mothers persist in prolonged bottle feeding?’ Aim: To use grounded theory procedures and techniques to analyse the qualitative data obtained from mothers and to generate an emerging theory of prolonged bottle feeding. Method: A series of individual in-depth interviews were conducted with 34 mothers of children with nursing caries. The children were aged between 3 and 4 years. Data were analysed using the grounded theory procedures and techniques of open and selective coding. Results: The core category or the mothers’ main concern that emerged from the data was conceptualized as ‘buying time’. The feeding bottle bought time away from crying children by silencing them but also bought extra time with the child. Therefore, two different behavioural styles or categories of buying time emerged. These were: (i) to buy time away from the demands of their crying toddlers (instant solutions) and (ii) to buy extra time with their ‘toddler-babies’ (double-binding). The feeding bottle acted as an ‘instant solution’ as on seeing the bottle the child would instantly ‘stop crying’ and peace would reign. Double-binding described how the feeding bottle was used to buy extra time for ‘babyhood closeness’ between mother and child while exposing the mothers’ harsh rejecting behaviours. Discussion: An understanding of the time concerns that the mothers experienced when caring for their young children and how they resolve them provides an important insight into the reasons for prolonged bottle feeding. [ABSTRACT FROM AUTHOR]

This study investigated whether the behaviors from the Dental Discomfort Questionnaire (DDQ) could help identify toothaches in children with a learning disability, who have a limited capacity to self-report. The objectives were to examine whether the behaviors from the DDQ occur more often in children with a learning disability who have caries and a toothache than in children who do not have caries and a toothache; and secondly, to examine whether two additional items increase the specificity and sensitivity of the DDQ to recognize a toothache, in this particular population of children with a learning disability. The DDQ was completed by a convenience sample of 58 parents on behalf of their children: 31% girls, aged between 6 and 13 years (mean = 7.5, SD = 2.7). Of the total group, 26% (n = 15) suffered from a toothache and 43% (n = 25) had carious teeth. Children with caries and a toothache had a significantly higher mean DDQ score and displayed more toothache-related behaviors (e.g., problems with chewing, problems with brushing teeth) than children without caries or toothache. The DDQ seems to be a functional and easy-to-use instrument to alert parents to the presence of a toothache in this specific group of children with a learning disability. [ABSTRACT FROM AUTHOR]

Background. At the mention of dental treatment some children become overwhelmed by anxiety whereas others appear to take the news in their stride. Sometimes when anxious children attend dental treatment, they appear to cope, contain their fears, and passively submit to treatment, whereas others angrily refuse to open their mouths and a third group of children exist who seem to just ‘tough it out’ no matter how disagreeable or frightening dental treatment becomes. The question remains: why do children react so differently to dental treatment? Aim. This paper aims to provide a psychoanalytic explanation as to why children react and respond differently to dental treatment. Results. This paper proposes a psychoanalytic formulation based on the functionality of the family, parent–child dyads, child psychological development, and the child's emotional and actual life experiences. Conclusions. There is a need to understand the dynamic nature of child dental anxiety and to appreciate the hidden factors and underlying complexities associated with the anxious child who attends for dental treatment. [ABSTRACT FROM AUTHOR]

Background. A new version of the Modified Child Dental Anxiety Scale (MCDAS) was formed by adding a faces rating scale to the original numeric form. Aims. To describe the psychometric properties of the faces version of the Modified Child Dental Anxiety Scale (MCDASf), and to provide normative data for dental anxiety for children using the MCDASf. Design. To determine the test–retest reliability, 287 schoolchildren aged 8–10 years completed the MCDASf on two separate occasions 17 weeks apart. To determine the criterion validity, 207 schoolchildren aged 10–12 years completed the MCDASf and the CFSS-DS at the same sitting. Construct validity was assessed using a cohort of 206 consecutive child dental patients and their parents. Results. The MCDASf showed good test–retest reliability (intraclass correlation coefficient = 0.80) and internal consistency (Cronbach's alpha = 0.82). The MCDASf significantly correlated with the CFSS-DS ( r = 0.80, P < 0.001). Dental anxiety assessed using the MCDASf was related to the dmft ( t = −2.17, P = 0.03), DMFT ( t = −4.19, P < 0.001), and dental general anaesthetic experience ( t = −4.46, P < 0.01). The mean MCDASf score for the normative sample ( n = 475) was 19.81 (95% CI: 19.20, 20.43). Conclusions. The MCDASf is a reliable and valid measure of dental anxiety in children aged 8–12 years. [ABSTRACT FROM AUTHOR]

Abstract: Malignant mesothelioma (MM) is a fatal type of cancer. We studied the role of the redox-active protein thioredoxin-1 (Trx-1) in apoptosis induced in MM cells and their non-malignant counterparts (Met-5A) by α-tocopheryl succinate (α-TOS) and TNF-related apoptosis-inducing ligand (TRAIL). MM cells were susceptible to α-TOS and less to TRAIL, while Met-5A cells were susceptible to TRAIL and resistant to α-TOS. MM cells expressed very low level of the Trx-1 protein, which was high in Met-5A cells, while the level of Trx-1 mRNA was similar in all cell lines. Downregulation of Trx-1 further sensitised Met-5A cells to TRAIL but not to α-TOS. Our data suggest that the role of Trx-1 in apoptosis modulation is unrelated to its anti-oxidant properties. [Copyright &y& Elsevier]

Objectives: The aim of the study was to assess the reliability and construct validity of the Child Oral Health-Related Quality of Life for 8–10-year-olds (COHRQoL [8–10]) using confirmatory factor analysis (CFA) and to test the measurement properties of latent variables believed to define the multidimensional construct of OHRQoL. Methods: A convenience sample of 270, year 4 children from six schools was obtained. The administered questionnaire included the 25-item COHRQoL [8–10] and the Coopersmith Self-Esteem Inventory-School Form. The analytical method was based upon CFA using maximum likelihood estimation. A second-order factoring approach was applied to determine the extent that the latent variables tapped a single over-arching domain of quality of life. Results: Seven items were withdrawn for low endorsement and poor association with resultant factors. The COHRQoL [8–10] was confirmed to measure a single construct of three latent variables invariant to gender. Internal consistency of the three scales derived comprising a total of 18 retained items was acceptable. Associations with self-esteem and with a single question on the extent that the mouth was a problem were confirmed and strengthened the construct validity of the COHRQoL [8–10] measure. Conclusions: Reliability and construct validity were demonstrated for COHRQoL [8–10] and supported the scale for adoption as an epidemiological and scientific tool for group comparisons. CFA showed that the three constructs or latent variables underlying the overall COHRQoL ratings were discrete measures that can be reliably assessed in children. Further model testing with additional data will increase generalization of these findings. [ABSTRACT FROM AUTHOR]

Gorter RC, Freeman R. Dentist–assistant communication style: perceived gender differences in The Netherlands and Northern Ireland. Community Dent Oral Epidemiol 2005; 33: 131–40.© Blackwell Munksgaard, 2005To assess communication style differences with the (female) dental assistant, as perceived by male and female dentists.Data were collected from 216 Dutch (male: 99; female: 117) and 261 Northern Irish (male: 135; female: 126) dentists (overall response rate: 60%). Respondents filled in a self-report questionnaire (one follow-up mailing), with 22 items on staff communication style. Using principal component analysis, four distinguishable factors could be extracted: businesslike leadership style (seven items, Cronbach'sα = 0.87), friendly leadership style (seven items,α = 0.87), professional interacting style (four items,α = 0.83) and gender interacting style (four items,α = 0.83).manovaindicated a main effect for gender [F(8,946) = 10.905,P < 0.001] and for country [F(4,474) =4.197,P = 0.002] on the communication style scales. Male dentists, compared with female colleagues, showed higher mean scores on businesslike leadership style and gender interacting style, whereas female dentists showed higher mean scores on friendly leadership style and professional interacting style. Dutch dentists showed higher mean scores on friendly leadership style and professional interacting style than their Northern Irish colleagues. No interaction effect between gender and country was found. Dentist's age and length of assistant's employment (in years) partly explained differences in means.Male and female dentists perceive their communication with the assistant differently; male dentists tend to be influenced by the gender differences, female dentists by striving for friendliness. Some country differences were found. Increasing influx of young female dentists underlines the relevance of this topic in dental education and for future research. [ABSTRACT FROM AUTHOR]

Objectives: To determine the degree of psychological distress, the experience of emotional exhaustion, and the extent of stress associated with course work in dental students and to compare these measurements among seven European dental schools. Design: Multi-centred survey. Setting: Dental Schools at Amsterdam, Belfast, Cork, Greifswald, Helsinki, Liverpool and Manchester. Participants: 333 undergraduate first-year dental students. Measures: General Health Questionnaire (GHQ12), Maslach Burnout Inventory (MBI), Dental Environment Stress Questionnaire (DES), demographic variables. Procedure: Questionnaire administered to all students attending first year course. Completed questionnaires sent to central office for processing. Results: Seventy-nine percent of the sampled students responded. Over a third of the students (36%) reported significant psychological distress (morbidity) at the recommended cut-off point (>3 on GHQ). These scores were similar to those reported for medical undergraduates. Twenty-two percent recorded comparatively high scores on emotional exhaustion. A wide variation in these 2 measurements was found across schools ( p's<0.001). Stress levels indicated by the DES were less variable ( p>0.5). Some evidence showed that contact with patients and the level of support afforded by living at home may be protective. Conclusion: Higher than expected levels of emotional exhaustion were found in a large sample of first-year undergraduate dental students in Europe. [ABSTRACT FROM AUTHOR]

Objectives: The need to assess both lay and professional views of oral health is believed to be at the centre of success when providing dental health care for older patients. Self-perceived physical (oral) health and perceptions of psychosocial functioning must be included if expressed need is to be assessed. The aim of this work was to construct an expressed need schedule and to assess the ability of this assessment to predict older community-based patients' satisfaction with complete dentures.Design: Survey of 260 people aged 65 years and over.Setting: Community setting.Main Outcome Measures: The participants were interviewed using a 55 item modified version of the Oral Health Impact Profile (OHIP) to assess their psychological, social and perceptions of their oral health. All participants were subjected to an oral examination.Results: The results showed that complete denture wearers compared had greater experience of difficulties associated with oral health and psychological functioning. Factor analysis allowed the identification of three dimensions associated with psychological, social and self-perceived physical (oral) health. When these factors were regressed with normative denture treatment need against satisfaction with complete dentures, satisfaction was characterised by high self-perceived physical (oral) health, low social health problems and no identifiable normative need.Conclusion: This work supports the inclusion of self-perceived physical (oral) health and psychosocial health (expressed need) questions in a schedule when predicting satisfaction with complete dentures. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the study is to assess the reliability and validity of a schedule to determine the normative denture treatment needs of older people.Design: The design used assessed inter-examiner reliability (criterion validity), test-retest reliability, and content and face validity of the schedule.Setting: The inter-examiner reliability study took place in a Department of Prosthetic Dentistry, the remainder of the work took place in a community setting.Results: The results showed that the schedule in terms of an index performed well with reasonable inter-examiner and test-retest reliability. Difficulties however were encountered with regard to subjective judgements about denture quality and design; consequently, there was modest inter-examiner agreement for stability, retention, and occlusal balance.Conclusions: The findings from this preliminary work suggest that the schedule may be useful in the assessment of normative denture treatment need in a community setting. Nevertheless more work will be required to obtain further information on the validity of this new assessment measure. [ABSTRACT FROM AUTHOR]

Examines how physical and psychosocial factors associated with child and parent, influenced dentists' sedation choice when a child presents with pain. Influences of dental caries, age, dental anxiety and dental health behavior; Criteria for children needing dental general anesthesia; Promotion of less anxiety provoking forms of anesthesia.

The aim of the study was to investigate the determinants of reported snack consumption in adolescents residing in Belfast, Northern Ireland and Helsinki, Finland. Ten % random samples of 14±15 yr old Belfast (n∼628) and Helsinki (n∼600) adolescents were obtained. A questionnaire assessed their demography, oral health knowledge, attitudes and the consumption of cariogenic snacks containing non-milk extrinsic sugars (NMES). Five hundred and eighty-nine (94%) questionnaires were returned in Belfast and 441 (74%) questionnaires in Helsinki. Belfast adolescents had significantly higher levels of oral health knowledge and higher consumption rates for snacks containing NMES. The Helsinki adolescents had more positive attitudes towards their oral health. Multivariant analysis showed that demography was the most direct determinant of cariogenic snacking. The acquisition of oral health knowledge played a minor role. There is a need to develop tailored and focused programmes to promote healthier snacking regimes in adolescents. [ABSTRACT FROM AUTHOR]

The political violence which took place in Northern Ireland was hypothesised (Fraser, Brit. J. Psychiat. 1971; 118: 257-264; Lyons, Brit. j . Psychiat. 1971; 118: 265-273; Lyons, J. Psychosomat. Res. 1979; 23; 373-393) to increase psychological stress in its population. This assumption led to the validity of work conducted in 1992 to assess Belfast dental students' stress to he questioned by researchers. An identical survey of clinical students was conducted in 199S, during the 1994-96 cease-fire in order to compare this additional cohort with the original cohort of clinical students' (from 199 Z) psychological stress. One hundred and seventy-nine students, in total, completed the occupational stress indicator. The results showed that there was no effect of year or the interaction of gender by year for sources of stress, type A behaviour, social support, health behaviours or stress outcomes. The main effect of gender explained differences in social support, alcohol consumption and the outcomes of stress (ie physical and mental ill-health). The findings suggest that social support, cohesiveness and group identity may act to contain the psychological stress associated with the political violence in Northern Ireland. [ABSTRACT FROM AUTHOR]

This is a brief review of the rationale for estrogen replacement as prevention of coronary artery disease. Epidemiological data suggest that premarin (0.625 mg) together with medroxyprogesterone acetate (2.5 mg) can prevent or delay the onset of coronary artery disease in postmenopausal women. The major effects of estrogens are: improving the lipid profile by lowering low density lipoprotein and raising high density lipoprotein; acting on vessel walls to reduce intimal damage and plaque formation; dilating vessels by both an endothelial dependent and an independent pathway; and acting as an antioxidant, thereby reducing the oxidation of low density lipoprotein and increasing the production of nitric oxide locally in the blood vessel. Oral estrogens and transdermal estrogens may act differently on coagulation factors and lipids. The role of specific estrogen receptor modulators as possible treatment for postmenopausal women in part will depend on the effect of these drugs in preventing coronary artery disease. The specific estrogen receptor modulators decrease low density lipoprotein and prevent triglyceride increases but it is unknown if they have estrogenic effects on blood vessel walls. Better compliance with estrogen replacement therapy will depend on educating women about their risk of getting coronary artery disease, and assisting them in decision making, as well as reducing side effects. The Heart and Estrogen/Progestin Replacement Study provides evidence that Prempro™ (Premarin/medroxyprogesterone acetate) should not be given to someone who already has heart disease without careful monitoring. [ABSTRACT FROM AUTHOR]

The mechanisms by which adolescents make food choices are not clear. The interaction and combination of the many social and psychological factors must be considered when examining adolescents' decision-making processes for sound food choices. The aim of this investigation is to examine one specific food choice, namely, the use of sucrose in hot drinks. One hundred and eighty-seven adolescents in their 16th year completed a questionnaire on the consumption of sugar using the method developed by AJZEN & FISHBEIN in their 'Theory of Reasoned Action'. The group was randomly divided into two groups so that decision-making processes with respect to two behavioural intentions - adding sugar to tea and coffee and excluding it - could be examined. The findings suggest that the immediate pleasurable taste of sugar outweighed and deferred the recognition of dangers associated with its consumption. Past dental health experiences, behaviours and education together with the role of parental figures acted as important influences. An awareness of these factors should assist dental health professionals to highlight the importance of sound food choices when negotiating dental health goals with adolescents. [ABSTRACT FROM AUTHOR]

Factors which influence health professionals' willingness to treat HIV seropositive patients have been explained in terms of the concept of dangerousness. Can this concept he used as a vehicle to explain dentists' responses? All dentists currently in practice in Northern Ireland (n=664) were invited to take part in the study. A final valid response rate of 73.3% was achieved. Attitudes and behavioural aspects of dental practice were examined in relation to whether they had or had not treated and HIV seropositive patients. In addition correlation and factor analyses were conducted. The results indicated that the concept of 'dangerousness' provides a useful framework to explain dentists' attitudes and behaviours with respect to the provision of dental care for this patient group. [ABSTRACT FROM AUTHOR]

The object of this review is to examine toothbrushing as a health behavior in European adolescents. The aims are to investigate the role of environmental and social factors on toothbrushing as a health behavior, to illustrate the importance of such factors in the prevention of periodontal diseases and to demonstrate how a knowledge of these factors can aid the development of specific health education programs. In order to do this the results of many studies concerned with oral hygiene behavior from different European countries have been examined. It is from the detailed study of these various European investigations that the results section is composed. The findings from this review demonstrate that toothbrushing as a health behavior is influenced by both environmental and social factors, that both of these factors affect the incidence of gingivitis and periodontal disease in the countries examined, and that when they are incorporated into health education programs based on the community development approach they can aid behavior change. [ABSTRACT FROM AUTHOR]

ABSTRACT Burning Mouth Syndrome (BMS) is described as a burning sensation of the oral mucosa, tongue, palate, lips and pharynx. The case material presented in this paper illustrates a strong psychogenic element in the aetiology of BMS. Conclusions are drawn on the basis that the patient's material suggests that the recovery of memories played a part in the resolution of her symptoms. The importance this has for psychotherapists is that it allows a reappraisal of the value of using psychoanalytic constructs as a means of understanding the mental representation, symbolisation and psychopathology of conditions of a psychogenic nature. [ABSTRACT FROM AUTHOR]

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The use of estrogens in postmenopausal women has been the subject of much controversy regarding hormone formulation, dosage, use in combination with progestins, duration of treatment, and contraindications. Estrogens have been prescribed to relieve menopausal symptoms for more than three decades. The hormones reduce the gynecologic and psychologic changes associated with menopause while inhibiting bone resorption and possibly reducing the risk of cardiovascular disease. Their use however has been complicated by an increased risk of endometrial cancer and possibly breast cancer. The use of estrogens as cardioprotective agents is discussed and the clinical experiences and the possible mechanisms of action are reviewed. The clinical pharmacology of estrogens and the various formulations that are available as monotherapy or in combination with progestins will also be reviewed. [ABSTRACT FROM AUTHOR]

Focuses on the expansion of traditional nursing role. Extension of the social and interpersonal components of nursing practice; Implications for nursing practice; Functions of nurses in health care.

The article examines factors, which increase the probability of periodontal disease in individuals. One factor, which is known to affect individual's susceptibility to disease, is stress. Since stress-related illnesses associated with the work place are commonly experienced and occupational stress is quantifiable, it seemed appropriate to investigate the effect of occupational stress upon periodontal health. According to findings, 88% of individuals attended the dentist every six months whereas 88% brushed their teeth at least twice a day. Significant increases in mean plaque score, sub-gingival calculus, bleeding on probing and pocket depth were demonstrated.