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Introduction: An economic evaluation (EE) was conducted alongside a randomized controlled trial (the Protecting Teeth @ 3 Study [PT@3]), exploring the additional preventive value of fluoride varnish (FV) application at 6-monthly intervals in nursery schools compared to treatment as usual (TAU) in the same nurseries. TAU represented a multicomponent national child oral health improvement intervention, the Childsmile program, apart from nursery FV., Methods: The EE was a within-trial cost-utility analysis (CUA) comparing the FV and TAU groups. The CUA was conducted from a National Health Service perspective and followed relevant methods guidance. Within-trial costs included intervention costs and health care resource use costs. Health outcomes were expressed in quality-adjusted life years (QALYs) accrued over the 2-y follow-up period. The Child Health Utility 9 Dimensions questionnaire was used to obtain utility scores. National reference costs were used, a discount rate of 1.5% for public health interventions was adopted, multiple imputation methods for missing data were employed, sensitivity analyses were conducted, and incremental cost-utility ratios were calculated., Results: Data from 534 participants from the 2014-2015 PT@3 intake were used in the EE analyses, n = 265 (50%) in the FV arm and n = 269 (50%) in the TAU arm. Mean incremental cost per child in the FV arm was £68.37 ( P = 0.382; 95% confidence interval [CI], -£18.04 to £143.82). Mean incremental QALY was -0.004 ( P = 0.636; 95% CI, -0.016 to 0.007). The probability that the FV intervention was cost-effective at the UK £20,000 threshold was 11.3%., Conclusion: The results indicate that applying FV in nurseries in addition to TAU (all other components of Childsmile, apart from nursery FV) would not be deemed cost-effective given current UK thresholds. In view of previously proven clinical effectiveness and economic worthiness of the universal nursery toothbrushing component of Childsmile, continuation of the additional, targeted nursery FV component in its pre-COVID-19 form should be reviewed given its low probability of cost-effectiveness., Knowledge Transfer Statement: The results of this study can be used by child oral health policy makers and dental public health professionals. They can form part of the evidence to inform the Scottish, UK, and international guidance on community-based child oral health promotion programs.

Objectives: To describe and summarize evidence on economic evaluations (EEs) of primary caries prevention in preschool children aged 2 to 5 years and to evaluate the reporting quality of full EE studies using a quality assessment tool., Methods: A systematic literature search was conducted in several databases. Full and partial EEs were included. The reporting quality of full EE studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist., Results: A total of 808 studies were identified, and 39 were included in the review. Most papers were published between 2000 and 2017 and originated in the United States and the United Kingdom. The most common type of intervention investigated was a complex multicomponent intervention, followed by water fluoridation. Cost analysis and cost-effectiveness analysis were the most frequently used types of EE. One study employed cost-utility analysis. The proportion of full EEs increased over time. The parameters not reported well included study perspective, baseline year, sensitivity analysis, and discount rate. The CHEERS items that were most often unmet were characterizing uncertainty, study perspective, study parameters, and estimating resources and costs., Conclusions: Within the past 2 decades, there has been an increase in the number of EEs of caries prevention interventions in preschool children. There was inconsistency in how EEs were conducted and reported. Lack of preference-based health-related quality-of-life measure utilization in the field was identified. The use of appropriate study methodologies and greater attention to recommended EE design are required to further improve quality., (Copyright © 2020 ISPOR–The Professional Society for Health Economics and Outcomes Research. Published by Elsevier Inc. All rights reserved.)

Aim To explore the time taken and the types of communication strategies used by dental health professionals (DHPs) when interacting with and providing fluoride varnish and oral health advice to children with their parents.Methods A video observational study was conducted to explore the types of communication strategies used by DHPs when interacting with child patients and their parents during preventive oral healthcare appointments. Three dentists and two extended duty dental nurses (EDDNs) from four general dental practices were recruited in East of Scotland. Forty-four child-parent dyads participated in the study. Verbal and non-verbal behaviours were coded with Observer XT 10.5 using the PaeD-TrICS coding scheme. Frequencies of communication behaviours were compared using Mann-Whitney U-tests.Results The communication during the preventive care appointment ranged in time from 130 seconds to 1,756 seconds with an average of 736 seconds. The total number of communication strategies (verbal and non-verbal behaviours) based on 44 video observations was 7,299. DHPs used different communication strategies when providing fluoride varnish application (FVA) and oral health advice. Dentists used more direct communication strategies to elicit child patients' cooperation in FVA. EDDNs used communication behaviours to maintain a balanced relationship with children. Consequently, children exhibited different responses to the two different dental professional groups.Conclusions Differences in the style of communication strategies existed between the participating DHPs when interacting with children during preventive dental appointments. Further work is required to confirm these initial findings.

Background: Dental caries in the expanding elderly, predominantly-dentate population is an emerging public health concern. Elderly individuals with heavily restored dentitions represent a clinical challenge and significant financial burden for healthcare systems, especially when their physical and cognitive abilities are in decline. Prescription of higher concentration fluoride toothpaste to prevent caries in older populations is expanding in the UK, significantly increasing costs for the National Health Services (NHS) but the effectiveness and cost benefit of this intervention are uncertain. The Reflect trial will evaluate the effectiveness and cost benefit of General Dental Practitioner (GDP) prescribing of 5000 ppm fluoride toothpaste and usual care compared to usual care alone in individuals 50 years and over with high-risk of caries., Methods/design: A pragmatic, open-label, randomised controlled trial involving adults aged 50 years and above attending NHS dental practices identified by their dentist as having high risk of dental caries. Participants will be randomised to prescription of 5000 ppm fluoride toothpaste (frequency, amount and duration decided by GDP) and usual care only. 1200 participants will be recruited from approximately 60 dental practices in England, Scotland and Northern Ireland and followed up for 3 years. The primary outcome will be the proportion of participants receiving any dental treatment due to caries. Secondary outcomes will include coronal and root caries increments measured by independent, blinded examiners, patient reported quality of life measures, and economic outcomes; NHS and patient perspective costs, willingness to pay, net benefit (analysed over the trial follow-up period and modelled lifetime horizon). A parallel qualitative study will investigate GDPs' practises of and beliefs about prescribing the toothpaste and patients' beliefs and experiences of the toothpaste and perceived impacts on their oral health-related behaviours., Discussion: The Reflect trial will provide valuable information to patients, policy makers and clinicians on the costs and benefits of an expensive, but evidence-deficient caries prevention intervention delivered to older adults in general dental practice., Trial Registration: ISRCTN: 2017-002402-13 registered 02/06/2017, first participant recruited 03/05/2018. Ethics Reference No: 17/NE/0329/233335. Funding Body: Health Technology Assessment funding stream of National Institute for Health Research. Funder number: HTA project 16/23/01. Trial Sponsor: Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL. The Trial was prospectively registered.

Background: Dental caries is the most common chronic disease of adult and childhood, a largely preventable yet widespread, costly public health problem. This study identified patient-, organization-, and system-level factors influencing routine delivery of recommended care for prevention and management of caries in primary dental care., Methods: A convergent mixed-methods design assessed six guidance-recommended behaviours to prevent and manage caries (recording risk, risk-based recall intervals, applying fluoride varnish, placing preventive fissure sealants, demonstrating oral health maintenance, taking dental x-rays). A diagnostic questionnaire assessing current practice, beliefs, and practice characteristics was sent to a random sample of 651 dentists in National Health Service (NHS) Scotland. Eight in-depth case studies comprising observation of routine dental visits and dental team member interviews were conducted. Patient feedback was collected from adult patients with recent checkups at case study practices. Key informant interviews were conducted with decision makers in policy, funding, education, and regulation. The Theoretical Domains Framework within the Behaviour Change Wheel was used to identify and describe patient-, organization-, and system-level barriers and facilitators to care. Findings were merged into a matrix describing theoretical domains salient to each behaviour. The matrix and Behaviour Change Wheel were used to prioritize behaviours for change and plan relevant intervention strategies., Results: Theoretical domains associated with best practice were identified from the questionnaire (N-196), case studies (N = 8 practices, 29 interviews), and patient feedback (N = 19). Using the study matrix, key stakeholders identified priority behaviours (use of preventive fissure sealants among 6-12-year-olds) and strategies (audit and feedback, patient informational campaign) to improve guidance implementation. Proposed strategies were assessed as appropriate for immediate implementation and suitable for development with remaining behaviours., Conclusions: Specific, theoretically based, testable interventions to improve caries prevention and management were coproduced by patient-, practice-, and policy-level stakeholders. Findings emphasize duality of behavioural determinants as barriers and facilitators, patient influence on preventive care delivery, and benefits of integrating multi-level interests when planning interventions in a dynamic, resource-constrained environment. Interventions identified in this study are actively being used to support ongoing implementation initiatives including guidance, professional development, and oral health promotion.

Background: Childsmile School adopts a directed-population approach to target fluoride varnish applications to 20% of the primary one (P1) population in priority schools selected on the basis of the proportion of enrolled children considered to be at increased-risk of developing dental caries. The study sought to compare the effectiveness of four different methods for identifying individuals most in need when a directed-population approach is taken., Methods: The 2008 Basic National Dental Inspection Programme (BNDIP) cross-sectional P1 Scottish epidemiological survey dataset was used to model four methods and test three definitions of increased-risk. Effectiveness was determined by the positive predictive value (PPV) and explored in relation to 1-sensitivity and 1-specificity., Results: Complete data was available on 43,470 children (87% of the survey). At the Scotland level, at least half (50%) of the children targeted were at increased-risk irrespective of the method used to target or the definition of increased-risk. There was no one method across all definitions of increased-risk that maximised PPV. Instead, PPV was highest when the targeting method complimented the definition of increased-risk. There was a higher percentage of children at increased-risk who were not targeted (1-sensitivity) when caries experience (rather than deprivation) was used to define increased-risk, irrespective of the method used for targeting. Over all three definitions of increased-risk, there was no one method that minimised (1-sensitivity) although this was lowest when the method and definition of increased-risk were complimentary. The false positive rate (1-specificity) for all methods and all definitions of increased-risk was consistently low (<20%), again being lowest when the method and definition of increased-risk were complimentary., Conclusion: Developing a method to reach all (or even the vast majority) of individuals at increased-risk defined by either caries experience or deprivation is difficult using a directed-population approach at a group level. There is a need for a wider debate between politicians and public health experts to decide how best to reach those most at need of intervention to improve health and reduce inequalities.

We aimed to assess the association between the roll-out of the national nursery toothbrushing program and a reduction in dental decay in five-year-old children in a Scotland-wide population study. The intervention was supervised toothbrushing in nurseries and distribution of fluoride toothpaste and toothbrushes for home use, measured as the percentage of nurseries participating in each health service administrative board area. The endpoint was mean d(3)mft in 99,071 five-year-old children, covering 7% to 25% of the relevant population (in various years), who participated in multiple cross-sectional dental epidemiology surveys in 1987 to 2009. The slope of the uptake in toothbrushing was correlated with the slope in the reduction of d(3)mft. The mean d(3)mft in Years -2 to 0 (relative to that in start-up Year 0) was 3.06, reducing to 2.07 in Years 10 to 12 (difference = -0.99; 95% CI -1.08, -0.90; p < 0.001). The uptake of toothbrushing correlated with the decline in d(3)mft (correlation = -0.64; -0.86, -0.16; p = 0.011). The result improved when one outlying Health Board was excluded (correlation = -0.90; -0.97, -0.70; p < 0.0001). An improvement in the dental health of five-year-olds was detected and is associated with the uptake of nursery toothbrushing.

Aim: To assess the current awareness, usage and opinion of the Hall technique as a restorative option for primary molars in Scottish general dental practice; and to identify preferences for methods of further training, if desired, for those not currently using the technique., Study Design: A postal questionnaire was sent to a random sample of Scottish general dental practitioners (GDPs) (n= 1207). Half of all GDPs within each health board were mailed. All analyses have been carried out in Minitab (version 15). The study is primarily descriptive and uses frequency distributions and cross-tabulations. Percentages are reported with p5% confidence intervals. Characteristics of the whole sample were reported. However when reporting the use of the Hall technique, only those GDP's reporting to treat children, at least sometimes are considered., Results: Following two mail-shots, the overall response rate was 59% (715/1207). Eighty-six percent (616/715) of respondents were aware of the Hall technique as a method of restoring primary molars and 48 % (n=318) were currently using the Hall technique. Of those GDPs who never used the Hall technique (51% of total respondents; n=340), 46% (n=157) indicated they were either 'very interested' or 'interested' in adopting the Hall technique into their clinical practice. The preferred source for further training was via a section 63 continuing professional development (CPD) course, incorporating a practical element., Conclusions: Of those GDPs in Scotland who responded to the questionnaire, an unexpectedly high number were already using the Hall technique in their practice, and among those not currently using it, there is a demand for training.

Objective: To report on the dental health of three-year-old children in Greater Glasgow, and to examine the amount of dental caries associated with deprivation in this young age group., Design: Dental inspections in nursery schools., Subjects and Methods: The national inspection programme using BASCD criteria was extended to include an additional group of nursery attending three-year-olds in Greater Glasgow in 2006/7 and 2007/8. Caries experience was analysed by logistic regression models and ROC plots., Results: Fourteen percent of this population was sampled in 2006/7 and 19% in 2007/8 (usable data n = 1,711 in 2006/7, 2,428 in 2007/8). Mean d(3)mft was 1.1 in 2006/7 and 1.0 in 2007/8. The prevalence of caries experience was 26% in 2006/7 and 25% in 2007/8 (33% and 32%, respectively, for children in deprived areas). The adjusted odds-ratio for caries experience for children living in the most deprived areas was 2.90 (2.31, 3.64), p <0.001. There was a high rate of caries in the upper anterior teeth., Conclusion: It was feasible to conduct large scale caries surveys of three-year-olds in a nursery setting. Poor dental health and inequality commence early in life. Caries prevention should be targeted toward deprived families from birth.

This paper, the second of two reviewing the Childsmile programme, describes monitoring arrangements and summarises monitoring data covering the period 2006-2009. By mid-2009, around 28,000 infants in deprived areas of the West of Scotland had been given caries risk assessments by Health Visitors; 14,000 were enrolled with 142 Childsmile practices or clinics; and over 10,000 had begun making practice visits. The Childsmile Nursery and School programmes had provided 28,000 fluoride varnish treatments to nursery and primary school children. Daily supervised toothbrushing and distribution of oral health packs covered almost 100% of nursery schools and P1 and P2 classes in primary schools in the most deprived areas of Scotland. Feedback of monitoring information to programme managers is used to identify any variation or shortfall in programme coverage and delivery.

This paper is the first of two reviewing the Childsmile programme. It sets out to describe the development and implementation of this national oral health improvement programme for children in Scotland over its initial three-year period (January 2006 to December 2008) and into its second phase of development. It outlines the context in which the initiative was conceived, the initial development of its various components, and how monitoring and evaluation are shaping the delivery and direction of the programme.

Many ethical issues are posed by public health interventions. Although abstract theorizing about these issues can be useful, it is the application of ethical theory to real cases which will ultimately be of benefit in decision-making. To this end, this paper will analyse the ethical issues involved in Childsmile, a national oral health demonstration programme in Scotland that aims to improve the oral health of the nation's children and reduce dental inequalities through a combination of targeted and universal interventions. With Scotland's level of dental caries among the worst in Europe, Childsmile represents one of the largest programmes of work aimed at combating oral health inequalities in the UK. The areas of ethical interest include several contrasting themes: reducing health inequalities and improving health; universal and targeted interventions; political values and evidence base; prevention and treatment; and underlying all of these, justice and utility.

The fissure-sealing of newly erupted molars is an effective caries prevention treatment, but remains underutilized. Two plausible reasons are the financial disincentive produced by the dental remuneration system, and dentists' lack of awareness of evidence-based practice. The primary hypothesis was that implementation strategies based on remuneration or training in evidence-based healthcare would produce a higher proportion of children receiving sealed second permanent molars than standard care. The four study arms were: fee per sealant treatment, education in evidence-based practice, fee plus education, and control. A cost-effectiveness analysis was conducted. Analysis was based on 133 dentists and 2833 children. After adjustment for baseline differences, the primary outcome was 9.8% higher when a fee was offered. The education intervention had no statistically significant effect. 'Fee only' was the most cost-effective intervention. The study contributes to the incentives in health care provision debate, and led to the introduction of a direct fee for this treatment.

Much of the research regarding the efficacy of fluoridated milk was obtained prior to the routine use of fluoridated dentifrices. The aim was to investigate, in situ, the effect of fluoridated and non-fluoridated milk on mineral change in artificial caries lesions, with the additional use of fluoridated dentifrice. The roles of different milk fluoride concentrations, volumes and frequencies in mineral change were studied. In total, 29 edentulous subjects were recruited and tooth blocks, containing artificial caries lesions, were inserted into their full dentures at 4 areas (sites). Each subject followed 5 randomly ordered, 6-week beverage experiments: 0.5 mg of F in 200 ml of milk, 3 times per day; 1.5 mg of F in 200 ml of milk, once per day; 200 ml of milk, once per day; 200 ml of milk, 3 times per day, and no beverage (negative control). In addition, the subjects were allocated to 1 of 2 groups; experimental treatment only or treatment and dentifrice. Mineral change was measured with transverse microradiography. Statistical analysis was performed using 2-sample t tests and a general linear modelling procedure. For integrated mineral loss there was a statistically significant effect of group (p = 0.001), indicating fluoridated toothpaste significantly increased remineralisation. For lesion depth there was a statistically significant combined effect of 'group and site'. 'Experiment' had no statistically significant influence on change in integrated mineral loss or lesion depth. The study demonstrated that the use of fluoridated dentifrice twice per day had a positive effect on the remineralisation of caries lesions. However, no additional significant effect of fluoridated milk was observed., (Copyright 2008 S. Karger AG, Basel.)

Objective: To examine levels of dental caries of 5-year-olds attending multi-ethnic schools in Greater Glasgow and to explore the effects of deprived backgrounds and ethnic identity on their dental health., Design: Between October 2001 and February 2002 a cross-sectional dental epidemiology survey of a sample of 721 5-year-olds was undertaken in schools having at least 25 per cent of pupils from black or minority ethnic groups. Background data on participating children were obtained from school records, including: ethnic origin, mothers' ability to speak English, religion, and demographics. Statistical analyses included two way analysis of variance to determine the effect of ethnicity after adjusting for socio-economic factors., Results: Complete data were available for 649 (90%) children. The sample broadly divided into white (52%), Pakistani (33%), and other minority ethnic groups (15%). Based on repeat observations, diagnosis reliability was good (Kappa = 0.77). The caries experience of Pakistani children (d3mft = 4.1; 95% CI 3.6 to 4.6) was significantly higher (p < 0.001) than the white children (d3mft = 2.3; 95% CI 1.9 to 2.6). Only 25% (95% C1 17 to 34) of the Pakistani children had no obvious decay, significantly lower (p < 0.001) than their white contemporaries (48%, 95% CI 39 to 58). Pakistani ethnic origin was associated with significantly higher levels of dental caries (p < 0.001), after adjusting for socio-economic deprivation., Conclusion: Children from deprived backgrounds have worse dental caries levels than their affluent counterparts and, over and above this effect, minority ethnic children of Pakistani background have higher levels than their white peers.

Aim: A community development oral health promotion programme based on the principles of the Ottawa Charter was conducted in an attempt to improve the dental health of children under 5 years of age in two severely socioeconomically challenged pilot districts in Glasgow, UK. Later phased extension involved all of the area's most deprived communities. The aim of the present study was to assess dental health outcomes by secondary analysis of routine caries datasets for Glasgow 5-year-olds over the interval from 1997-1998 to 2003-2004., Design: Wilcoxon tests assessed change in d3mft scores and logistic regression was used to analyse binomial scores (e.g. % d3mft = 0)., Results: After adjusting for age and deprivation (DepCat) in pilot districts 1 and 2, significant redistributions of the relative frequency of d3mft scores were observed (P = 0.012 and P < 0.001, respectively), mean d3mft decreased from 5.5 to 3.6 and from 6.0 to 3.6, respectively, and the proportions with d3mft = 0 increased from 11% to 29% and from 10% to 32%, respectively [P = 0.010, odds ratio (OR) = 0.25, and P = 0.006, OR = 0.30, respectively, for d3mft > 0]. Following extension of the programme into all of Glasgow's socioeconomically challenged areas, the mean d3mft values of 5-year-olds reduced in all DepCat 7 communities, and across Glasgow as a whole from 4.9 to 4.1 and from 3.5 to 3.1, respectively, while the proportion with d3mft = 0 increased from 20% to 32% (P < 0.001) and from 34% to 42% (P < 0.001), respectively., Conclusion: Dental health improvements were observed in pilot districts and across all DepCat 7 communities following the roll-out of the programme. This change was of sufficient magnitude to impact upon area-wide statistics for Glasgow.

Background: Atraumatic Restorative Treatment (ART) was introduced a decade ago as a minimal intervention treatment for caries in unindustrialised countries, but UK general dental practitioners (GDPs) may also be using this technique., Objective: This study aimed to determine the materials and techniques used by a group of UK GDPs to treat caries in primary teeth., Method: A questionnaire, designed to determine GDPs' use of materials and techniques in the restoration of caries in primary teeth, was distributed to 600 GDPs in Scotland and England, with an explanatory letter and reply-paid envelope. The questionnaire included colour illustrations of two carious cavities in primary molar teeth and a request that respondents draw the cavity outline that they would use on the illustrations. The cavity outlines were assessed independently by two examiners. All other data were collated and analysed., Results: 390 usable replies were received, a response rate of 65%. Of the respondents, 99% treated child patients and 42% of respondents were aware of ART. For treatment of a small Class II cavity, 37% drew a cavity outline without extension beyond removal of caries and a majority suggested use of an adhesive material (51% glass ionomer, 13% compomer). For cavity preparation, 47% of respondents used a drill, 10% an excavator and 41% used both. For treatment of a large occluso-lingual cavity, again most used an adhesive technique (44% glass ionomer, 12% compomer) for its restoration, while 50% used a drill, 7% an excavator and 42% used both for cavity preparation., Conclusion: Most respondents used adhesive materials for restoration of caries in primary molars, but, despite 42% of respondents stating that they were aware of the treatment, "true" ART was adopted by fewer than 10% of respondents.

Objective: To develop and evaluate NHS-based strategies likely to improve dental health and reduce inequalities in pre-5-year-old's oral health in Greater Glasgow, Scotland, by ecological study of community-based oral health promotion programmes in two of the area's most socio-economically deprived communities., Basic Research Design: Following an initial health service-based Oral Health Needs Assessment (OHNA) in a severely deprived community, culturally relevant dental health promotion interventions were initiated with multidisciplinary collaborative networks. Ecological studies to monitor dental health involved cross-sectional caries epidemiology of nursery children aged 36-59 months at baseline (1995/96), after two (1997/98) and four years (1999/00), in the G22 (pilot) and G33 post code areas. These areas had similar socio-economic status (SES), i.e. severe social deprivation., Results: At the outset, mean dmft scores in the pilot area for the age groups 36-47 months and 48-59 months were respectively 3.9 (95% CI 2.8 5.1) and 5.9 (95% CI 5.1-6.8), with the proportions of caries-free children being 38% and 17%, respectively. Reductions in mean dmft of 46% for the 36-47 month-olds and 37% for the 48-59 month-olds occurred in the pilot public health programme area over the four-year period; the proportions of caries-free children increased to 51% and 40%, respectively. During the first two years of the programme, increases in the mean dmft of 36-47 month- and 48-59 month-olds in the G33 (comparator) area were recorded. However, this trend was reversed significantly two years later following the introduction of a similar community development-based caries-prevention programme., Conclusion: While not being able to attribute causation, a programme of community development to promote the dental health of pre-school children residing in two socio-economically disadvantaged areas of Glasgow was associated with significant improvements in the dental health of these pre-school populations.

Aim: In recent years there have been a number of reviews and guidelines published with respect to the diagnosis and management of caries in children. Bitewing radiography remains the recommended method of choice for caries diagnosis in most circumstances. The aims of the study were to investigate the usage of bitewing radiography by general dental practitioners (GDPs) in Greater Glasgow, for the diagnosis of caries in children and to assess the usefulness of the technique as perceived by these dental practitioners., Design: A questionnaire for self completion was sent to all GDPs with an NHS list number in the Greater Glasgow area., Results: An 80% response rate was obtained with 303 GDPs responding. Less than half the dentists (44%) indicated that they always carried out caries risk assessments for all children, but 71% reported doing this for 6 and 7-year-old children. Approximately 60% of dentists stated they had read the recent radiation and caries management guidelines. Only 72% stated that they used radiography as a caries diagnostic tool in children, with 12 GDPs (4%) indicating they would never consider using bitewing radiography in children. Only 17% would consider taking bitewing radiographs in children under 6 years, and the majority of dentists (61%) reported that they would first consider taking radiographs in the 6-11-year-old age group. However, only a low proportion of children in this age band had dental x-rays taken. Bitewing radiography was considered to be more important for 12-year-olds than for 6-year-olds. Recommended methods for decreasing radiation exposure such as rectangular collimation and film holders were not being used universally, with 41% and 58% respectively using these devices., Conclusions: A significant proportion of dentists in Greater Glasgow are not complying with recent guidelines and recommendations and it would appear that the value of bitewing radiography as a diagnostic tool in children is not being fully exploited.

Unlabelled: Salt fluoridation is effective at inhibiting caries, but fluorosis prevalence data are deficient., Objectives: The purpose was to undertake a blind study of caries and tooth mottling in 8th grade school pupils from south-east Hungary who had resided (test) or not resided (control), until November 1985, in a 350 ppm F-/kg domestic salt-fluoridated area during their early years of life., Methods: In Szeged, blind clinical caries and anterior tooth mottling scoring (+10% repeats) of 49 previously salt-fluoridated (mean age 14.14 years) and 59 non-salt-fluoridated subjects (mean age 14.08 years) were undertaken by one examiner, in June 1997. In addition, radiographic and photographic recordings were taken. In Glasgow, four dental and two lay staff scored the projected 35 mm colour transparencies (+10% repeats) of each pupil's six upper anterior teeth, for tooth mottling. All clinical, radiographic and photographic data were then analysed., Results: Mean DMFS scores were 9.18 (SD=10.72) for test users and 4.51 (SD=6.24) for control users (P<0.01) and, based on repeat observations, clinical reliability=0.99; X-ray reliability=0.95. Clinically, three test children had fluorosis of 10 teeth, with eight teeth in two controls. Photographic scoring by the clinical examiner gave a 97.2% clinical match, while photographic agreements for all four dentist pairs were 92.5%-97.2%, with lay observers' agreements at 89.8%. For both groups, 10% repeats produced 98.5% agreements. In a sole test case "fluorosis" photographic unanimity was obtained, and non-unanimous "possible fluorosis" was recorded by two to four panel members for only three other test and two control subjects., Conclusions: No evidence was found that significant anterior tooth fluorosis resulted in subjects exposed previously to 350 ppm F-/kg domestic salt from birth to 2.3-4.8 years of age. However, no caries benefit was demonstrated after the 11.5-year salt fluoridation gap. Caries differences seemed social class-related, city-based controls having less disease than rural test subjects, in spite of an identical F- tablet regimen in all schools from 1987, until subjects were 10 years old. These data emphasise (a) the superiority of sustained community-delivered fluoridation and (b) the need to maintain constant fluoride delivery to tooth surfaces, certainly well beyond 10 years of age.

Salt fluoridation is effective at inhibiting caries, but fluorosis prevalence data are different. The purpose was to undertake a blind caries and tooth mottling study of 14-yrs-olds from S. E. Hungary who did (Test) or did not (Control) live, until 1985, in a 350 pp F-/kg salt fluoridated area during their early years of life. In Szeged, blind clinical and anterior tooth-mottling, radiographic and photographic recording of 49 previously salt-fluoridated and 59 non-salt-fluoridated subjects were undertaken by one examiner. In Glasgow, four dental and two lay staff scored the projected 35 mm colour transparencies of each pupil's teeth (13-23), for tooth mottling. Mean DMFS scores were 9.18 (SD = 10.72) and 4.51 (SD = 6.4) for Test and Control users respectively (p < 0.01). Clinically three Test children had fluorosis of 10 teeth, with 8 teeth in two Controls. In a sole Test case was "fluorosis" photographic unanimity obtained, and non-unanimous "possible fluorosis" was recorded by two-four 'jurors' for only three other Test and two Control subjects. No evidence was found that significant fluorosis resulted in subjects exposed previously to 350 ppm F-/kg salt early in life, but no caries benefit was demonstrated after the 11.5-yr salt fluoridation gap. These data emphasize (a) the superiority of substained community-delivered fluoridation, and (b) the need to maintain constant fluoride delivery to tooth surfaces, and certainly well beyond 10 years of age.

Strains of Streptococcus mutans isolated from the plaque of 6 subjects were studied using an in vitro model to determine whether differences in their cariogenic potential could be detected, and if so, whether the results correlated with the caries experience of the individuals. Each strain was incubated with a bovine enamel slab and 5% (w/v) sucrose for 24-h periods. The acidogenic potential was assessed by pH measurement and analysis of acid anion production. Microradiographic and microdensitometric assessment of the enamel, together with measurement of the change in calcium concentration of the reaction mixture were used to determine the demineralizing potential of each strain. Significant differences in cariogenic potential were found between some of the strains tested, and correlations were found between 3 of the test parameters and the decayed-missing-filled-surface score of the individuals. The results suggest that the caries experience of individuals may be related, to some extent, to the cariogenic potential of their S. mutans strains.

An intra-oral appliance model was used to investigate the composition of the plaque microflora associated with early enamel demineralization. Enamel sections, with exposed windows, were mounted on lower removable appliances, and the devices were worn by volunteers for three-week periods under three experimental conditions. These were: (1) "normal" plaque conditions, (2) extra-oral sucrose applications nine times daily, and (3) inoculation of each volunteer's own mutans streptococci onto the test sites and sucrose applications as described for (2). After 21 days, the plaque overlying each window was removed, and the bacterial composition was determined. Changes in mineral content of the associated enamel were measured by microradiography and microdensitometry, and the total mineral loss (delta z) that had occurred at each site was calculated. The 144 sites studied were divided into four demineralization groups by delta z value, with an increase in mineral loss from group 1 to group 4. A progressive and significant increase in the isolation frequency of mutans streptococci occurred from delta z group 1 to group 4 sites. These organisms were isolated from the plaque of every location with enamel mineral loss of over 1000 delta z units, but were not detected in 27% of the group 3 sites. Lactobacilli comprised 2% to 3% of the total cultivable microflora in groups 1-3 sites, but were found in significantly higher proportions (18%) at those enamel sites experiencing the most extensive mineral loss (group 4). No significant relationship was found between demineralization and the levels of Actinomyces species or Veillonella.(ABSTRACT TRUNCATED AT 250 WORDS)

Strains of Streptococcus mutans isolated from the plaque of 6 subjects were studied using an in vitro model to determine whether differences in their cariogenic potential could be detected, and if so, whether the results correlated with the caries experience of the individuals. Each strain was incubated with a bovine enamel slab and 5% (w/v) sucrose for 24-h periods. The acidogenic potential was assessed by pH measurement and analysis of acid anion production. Microradiographic and microdensitometric assessment of the enamel, together with measurement of the change in calcium concentration of the reaction mixture were used to determine the demineralizing potential of each strain. Significant differences in cariogenic potential were found between some of the strains tested, and correlations were found between 3 of the test parameters and the decayed-missing- filled-surface score of the individuals. The results suggest that the caries experience of individuals may be related, to some extent, to the cariogenic potential of their S. mutans strains. [ABSTRACT FROM AUTHOR]

Over a 20-minute period, subjects expectorated 8 samples of whole saliva (EWS) while chewing gum. Flow rates were calculated, and sucrose was analyzed in these samples as well as in saliva collected on filter paper strips from different tooth surfaces. Salivary film velocity (SFV), based on a 0.1-mm-thick film, was estimated from the clearance half-times of KCI in agarose disks positioned in different regions of the mouth. Salivary flow rate peaked at 5.1 mL/min in the first min but fell to about 1.25 mL/ min by the end of the 20 min of gum-chewing. In contrast, flow rate when subjects sucked sour lemon drops averaged about 5.3 mL/min throughout the 20-minute period. The mean salivary sucrose concentration during gum-chewing peaked in the second min at 384 mmol/L (13.1%) but had fallen to 14 mmol/L by the 15-20-minute time interval. The sucrose concentrations on the palatal surfaces of the upper incisors and the facial and lingual surfaces of the lower molars were not significantly different from that in EWS but were much lower on the facial surfaces of the upper incisors and molars, and on the lingual surfaces of the lower incisors. When flow was unstimulated, SFV was 0.8-1.0 mm/min on the facial surfaces of the upper incisors and lower molars but about 5-8 mm/min on the facial surfaces of the upper molars and on the lingual surfaces of the lower incisors and molars. During chewing-gum use, the SFV increased only to 4 and 10 mm/min on the facial surfaces of the upper incisors and lower molars, respectively, but on the facial surfaces of the upper molars and on the lingual aspects of the lower incisors and molars, it became equivalent to that in a well-stirred solution. This study showed that even during gum-chewing, which would be expected to facilitate the mixing of the different salivary secretions, the saliva provided a series of distinctly different fluid environments, some with cariogenic and others with calculogenic potential, for plaque in different regions of the mouth. [ABSTRACT FROM AUTHOR]