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Background/objectives: Over 60,000 patients in the United Kingdom are estimated to have artificial eyes. Manufacturing and hand-painting of artificial eyes have not changed significantly since 1948. Delays and colour-matching issues may severely impact a patient's rehabilitation pathway. Technology advances mean alternatives are now possible. This cross-over, randomised feasibility trial aimed to determine the feasibility of conducting a full-scale trial of the effectiveness and cost-effectiveness of digitally-printed artificial eyes compared to hand-painted., Subjects/methods: Patients aged ≥18 years who were longstanding artificial eye users requiring a replacement were randomised to receive either a hand-painted or digitally-printed eye first followed by the other type of eye. Participants were asked to approach a close contact (CC) willing to participate alongside them. A subset of participants, their CCs, and staff were interviewed about their opinions on trial procedures, artificial eyes, delivery times and satisfaction., Results: Thirty-five participants were randomised and 10 CCs consented. Participant retention at final follow-up was 85.7%. Outcome data completion rates ranged from 91-100%. EQ-5D-5L completion ranged from 83-97%. Resource-use completion ranged from 0-94% with total costs at £347 for hand-painted and £404 for digitally-printed eye. There were two adverse events. Twelve participants, five CCs, and five staff were interviewed. There were positive and negative features of both types of eyes. We identified that social and psychological wellbeing is affected, often for many years after eye removal. Participation in the feasibility study was well accepted., Conclusions: The feasibility study outcomes indicate that a full trial is achievable., Trial Registration Number: ISRCTN85921622., (© 2024. The Author(s).)

Background/objectives: Around 11,500 artificial eyes are required yearly for new and existing patients. Artificial eyes have been manufactured and hand-painted at the National Artificial Eye Service (NAES) since 1948, in conjunction with approximately 30 local artificial eye services throughout the country. With the current scale of demand, services are under significant pressure. Manufacturing delays as well as necessary repainting to obtain adequate colour matching, may severely impact a patient's rehabilitation pathway to a normal home, social and work life. However, advances in technology mean alternatives are now possible. The aim of this study is to establish the feasibility of conducting a large-scale study of the effectiveness and cost-effectiveness of digitally printed artificial eyes compared to hand-painted eyes., Methods: A cross-over, randomised feasibility study evaluating a digitally-printed artificial eye with a hand-painted eye, in patients aged ≥18 years with a current artificial eye. Participants will be identified in clinic, via ophthalmology clinic databases and two charity websites. Qualitative interviews will be conducted in the later phases of the study and focus on opinions on trial procedures, the different artificial eyes, delivery times, and patient satisfaction., Discussion: Findings will inform the feasibility, and design, of a larger fully powered randomised controlled trial. The long-term aim is to create a more life-like artificial eye in order to improve patients' initial rehabilitation pathway, long term quality of life, and service experience. This will allow the transition of research findings into benefit to patients locally in the short term and National Health Service wide in the medium to long term._., Isrctn Registration: ISRCTN85921622 (prospectively registered on 17/06/2021)., Competing Interests: Competing interests: All authors, with the exception of MT, have a proportion of their salaries covered by the research funding received.

Objectives: To conduct an early-phase feasibility study of an oral health intervention, Health visitors delivering Advice on Britain on Infant Toothbrushing (HABIT), delivered by Health Visitors to parents of children aged 9-12 months old., Design: A mixed-methods, early-phase, non-controlled, feasibility study., Participants: Recruitment consisted of Group A-HABIT-trained Health Visitors (n=11) and Group B-parents of children aged 9-12 months old about to receive their universal health check (n=35)., Setting: Bradford, West Yorkshire, UK., Intervention: A multidisciplinary team co-developed digital and paper-based training resources with health visitors and parents of young children. The intervention comprised of two components: (A) training for health visitors to deliver the HABIT intervention and (B) HABIT resources for parents, including a website, videos, toothbrushing demonstration and a paper-based leaflet with an oral health action plan., Primary and Secondary Outcome Measures: Recruitment, retention and intervention delivery were analysed as key process outcomes for Groups A and B. Group B demographics, self-reported toothbrushing behaviours, dietary habits and three objective measures of toothbrushing including plaque scores were collected at baseline, 2 weeks and 3 months post intervention., Results: HABIT intervention delivery was feasible. Although the intended sample size was recruited (Group A=11 and Group B=35) it was more challenging than anticipated. Retention of Group B participants to final data collection was satisfactory (n=26). Total compliance with toothbrushing guidelines at baseline was low (30%), but significantly improved and was maintained 3 months after the intervention (68%). Plaque scores improved post intervention and participants found video recording of toothbrushing acceptable. Dietary habits remained largely unchanged., Conclusion: This feasibility study has demonstrated that HABIT is an appropriate oral health intervention. Adaptions to the study design are recommended to maximise recruitment and data collection in a definitive study. These quantitative findings have demonstrated an early signal of impact for improved oral health behaviours for young children at high risk of decay., Trial Registration Number: ISRCTN55332414., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)

Background: Dental caries (tooth decay) in children is a national public health problem with impacts on the child, their family and wider society. Toothbrushing should commence from the eruption of the first primary tooth. Health visitors are a key provider of advice for parents in infancy and are ideally placed to support families to adopt optimal oral health habits. HABIT is a co-designed complex behaviour change intervention to support health visitors' oral health conversations with parents during the 9-12-month universal developmental home visit., Methods: A seven stage co-design process was undertaken: (1) Preparatory meetings with healthcare professionals and collation of examples of good practice, (2) Co-design workshops with parents and health visitors, (3) Resource development and expert/peer review, (4) Development of an intervention protocol for health visitors, (5) Early-phase testing of the resources to explore acceptability, feasibility, impact and mechanism of action, (6) Engagement with wider stakeholders and refinement of the HABIT intervention for wider use, (7) Verification, Review and Reflection of Resources., Results: Following preparatory meetings with stakeholders, interviews and co-design workshops with parents and health visitors, topic areas and messages were developed covering six key themes. The topic areas provided a structure for the oral health conversation and supportive resources in paper-based and digital formats. A five-step protocol was developed with health visitors to guide the oral health conversation during the 9-12 month visit. Following training of health visitors, an early-phase feasibility study was undertaken with preliminary results presented at a dissemination event where feedback for further refinement of the resources and training was gathered. The findings, feedback and verification have led to further refinements to optimise quality, accessibility, fidelity and behaviour change theory., Conclusion: The co-design methods ensured the oral health conversation and supporting resources used during the 9-12 month visit incorporated the opinions of families and Health Visitors as well as other key stakeholders throughout the development process. This paper provides key learning and a framework that can be applied to other healthcare settings. The structured pragmatic approach ensured that the intervention was evidence-based, acceptable and feasible for the required context., Trial Registration: ISRCTN55332414, Registration Date 11/11/2021., (© 2022. The Author(s).)

Competing Interests: Competing interests: We have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.

Background: To explore the acceptability of the oral health intervention, HABIT (Health visitors delivering Advice in Britain on Infant Toothbrushing) to parents with young children aged 9-12 months and health visitors., Methods: Following the delivery of the universal oral health intervention called HABIT, qualitative semi-structured interviews with parents and focus groups with health visitors were undertaken. Interviews were audio-recorded and transcribed. Health visitors completed self-reported diaries after delivering the HABIT intervention with parents. The qualitative data was analysed using framework analysis (guided by a theoretical framework of acceptability)., Results: Seventeen parents were interviewed, and five health visitors and three nursery nurses participated in two focus groups. Parents reported health visitors to be 'trusted' and valued the reassurance provided during the HABIT visit. Health visitors found the HABIT training and resources useful and valued the consistency and increased confidence in undertaking oral health conversations. There were, however, challenges in changing behaviour where families faced competing demands on time and resources. Both health visitors and parents described the importance of the intervention's timing and suggested that multiple visits may be needed to support optimal oral health habits., Conclusion: The HABIT intervention was acceptable to parents and health visitors. Health visitors would welcome a further refinement to enhance intervention delivery that specifically achieves a balance between using a guided script and retaining the flexibility to adapt the conversation to suit the needs of individual families. This, in turn, will maximise impact and enable parents of young children to adopt and maintain optimal home-based oral health behaviours for their child., (© 2022. The Author(s).)

Objectives: To compare the surface gloss and surface roughness of three contemporary composites when polished with reduced-step polishing systems or a conventional multiple-step technique., Methods: Fifty Discs (8 mm ø x 2 mm) were each fabricated from three composites; Essentia (ES), BRILLIANT EverGlow (EG), and Filtek Universal, (FU). 5 different polishing systems were randomly assigned 10 specimens from each composite group. The 'gold standard' multiple-step system consisted of Sof-Lex XT discs followed by DiaPolisher diamond paste (GC) (P1). The two-step systems were Polishettes (P2) and DIATECH ShapeGuard (P3) and the one-step systems used were; Opti1Step (P4) and OneGloss (P5). Surface gloss was measured using a glossmeter and surface roughness was measured by a profilometer. Statistical analysis was conducted using one-way ANOVA and Pearson correlation tests. Samples were also imaged across different length scales using scanning electron microscopy and macro-lens photography., Results: The highest gloss was obtained when P2 and P3 were used in all composite groups (p < 0.05). EG composite showed the lowest Sa (0.08 µm) when polished with P3 and highest gloss when polished with P2 (96.7 GU). Polishing with P5 resulted in highest Sa and lowest surface gloss in all composite groups (p < 0.05). A high correlation was found between Sa and gloss, r = 0.73 (p < 0.05). Both SEM and macro-lens photography supported quantitative data., Conclusion: Both two-step composite polishing systems produced superior gloss compared to the traditional multiple-step polishing system. Mean surface roughness (Sa) and surface gloss are highly correlated with each other., Clinical Significance: Some reduced step composite polishing systems tested in this study produced superior gloss outcomes compared to the traditional gold-standard multi-step polishing system. This may enable significant clinical chair-time reduction and faster polishing protocols., (Copyright © 2021. Published by Elsevier Ltd.)

Background: This service evaluation explores patient reported outcomes from patients provided with high definition ocular prostheses (artificial eyes)., Methods: Validated patient questionnaires (FACE-Q, DAS24 and HADS) were utilised to evaluate patient experiences of their new ocular prosthesis. 10 patients were included in the service evaluation, which was conducted between December 2018 and September 2019. Descriptive analysis of the mean and 95% CI was undertaken for all questionnaires. Statistical analysis was performed using SPSS 21 Principal Component Analysis (PCA) for FACE-Q questionnaires. Correlations were significant when factor loading is at α > 0.4., Results: A questionnaire response rate of 80% was achieved (n = 8). PCA analysis showed the number of variables tested could be reduced. Two principal components (PC1 and PC2) had very good to excellent internal consistency between variables with factor loading (α = 0.7-0.9). PC1 contained questionnaires 1-7, all of which were highly correlated. PC2 contained question number 8 with a factor loading of α = 0.8. This indicates good reliability, validity and responsiveness., Conclusions: We hope to demonstrate the importance of service evaluations with respect to rapidly evolving technological advances in medical devices, pharmaceuticals and imaging modalities. Further feasibility and full clinical studies are required to confirm the positive results of the novel artificial eye service we have evaluated with respect to the traditional approach.

The use of hand painting an iris button using oil paint remains the conventional method of artificial eye manufacturing. The authors found that replacing this technique with a digital photograph taken of a patient's unaffected eye offers several advantages over the conventional method but the process from capture to print must be standardised and colour accurate. The authors of this paper suggest a tried and tested formulated photographic process of capture and printing prior to polymerisation. It discusses issues that can arise and how these can be overcome in order to achieve a high-quality print that can be used to produce a 'life like' ocular prosthesis.

Background: Dental caries (tooth decay) in children is a worldwide public health problem. The leading cause of caries is poor oral hygiene behaviours and the frequent consumption of sugary foods and drinks. Changing oral health habits requires effective behaviour change conversations. The dental practice provides an opportunity for dental teams to explore with parents the oral health behaviours they undertake for their young children (0-5 years old). However, evidence suggests that dental teams need further support, training and resources. Therefore, "Strong Teeth" (an oral health intervention) was co-developed to help dental teams undertake these behaviour change conversations. The current paper will explore the acceptability of the "Strong Teeth" intervention with dental teams and parents of children aged 0-5 years old using multiple datasets (interviews, focus groups and dental team member diaries) METHODS: Following the delivery of the "Strong Teeth" intervention, qualitative interviews with parents and focus groups with dental team members were undertaken. Interviews were audio-recorded, transcribed and analysed using a theoretical framework of acceptability. The self-reported dental team diaries supplemented the interviews and focus groups and were analysed using framework analysis., Results: Four themes were developed: (1) integration within the dental practice; (2) incorporating the Oral-B electric toothbrush; (3) facilitating discussions and demonstrations; and (4) the practicality of the Disney Magic Timer app. Overall, the "Strong Teeth" intervention was acceptable to parents and dental teams. Parents felt the Oral-B electric toothbrush was a good motivator; however, the Disney Magic Timer app received mixed feedback on how well it could be used effectively in the home setting. Findings suggest that the intervention was more acceptable as a "whole team approach" when all members of the dental practice willingly participated., Conclusions: There are limited studies that use a robust process evaluation to measure the acceptability of an intervention. The use of the theoretical framework of acceptability helped identify aspects of the intervention that were positive and helped identify the interventions areas for enhancement moving forwards. Future modifications include enhanced whole team approach training to optimise acceptability to all those involved., Trial Registration: ISRCTN Register, (ISRCTN10709150).

This article provides an overview of how long COVID-19 (SARS-CoV-2) survives on the built environment, and reviews currently available resources to provide recommendations on effective decontamination of photographic equipment based within a secondary care setting.

This study evaluated the effectiveness of a peer-led oral hygiene education video in improving oral hygiene knowledge and behaviour in year 2 (6- to 7-year-old) and year 3 (7- to 8-year-old) children. A novel peer-led oral hygiene education video was created, in which a group of 6- to 10-year-old children delivered key oral hygiene messages. The video was then shown to children of the same age group, whom oral hygiene knowledge and behaviours were assessed before and after the video. Results found that the video was an effective method of improving overall oral hygiene knowledge. It was effective in improving specific aspects of oral hygiene such as knowledge of the frequency of brushing and toothpaste amount, and in the behaviour of using the toothbrush in a circular motion. It was not an effective method in improving the overall oral hygiene knowledge and behaviour of Year Two children, demonstrating children may develop significantly in just 1 year.

Background: Dental attendance provides an important opportunity for dental teams to explore with parents the oral health behaviours they undertake for their young children (0-5 years old). For these discussions to be effective, dental professionals need to be skilled in behaviour change conversations. The current evidence suggests that dental teams need further support, training and resources in this area. Therefore, the University of Leeds and Oral-B (Procter & Gamble Company) have worked with the local community and dental professionals to co-develop "Strong Teeth" (an oral health intervention), which is delivered in a general dental practice setting by the whole dental team. The protocol for this early phase study will explore the feasibility and acceptability of the Strong Teeth intervention to parents and the dental team, as well as explore short-term changes in oral health behaviour., Methods: Forty parents (20 of children aged 0-2 years old, and 20 of children aged 3-5 years old) who are about to attend the dentist for their child's regular dental check-up will be recruited to the study. Parents and children will be recruited from 4 to 8 different dental practices. In the home setting, consent and baseline oral health behaviour data will be collected. The researchers will ask parents questions about their child's oral health behaviours, including toothbrushing and diet. Three different proxy objective measures of toothbrushing will be collected and compared with self-report measures of parental supervised toothbrushing (PSB)., Discussion: The parent and child will then attend their dental visit and receive the Strong Teeth intervention, delivered by the dental team. This intervention should take 5-15 min to be delivered, in addition to the routine dental check-up. Furthermore, children aged 0-2 years old will receive an Oral-B manual children's toothbrush, and children aged 3-5 years old will receive an Oral-B electric rechargeable children's toothbrush. At 2 weeks and 2-3 months following the Strong Teeth intervention, further self-report and objective measures will be collected in the parent/child's home. This data will be supplemented with purposively sampled qualitative interviews with parents (approximately 3 months following the intervention) and dental team members (following delivery of the intervention)., Trial Registration: ISRCTN Register, (ISRCTN10709150)., Competing Interests: Competing interestsPD, KG-B and JO have received modest fees to speak to professional audiences about the Strong Teeth project. They have no other competing interests. The other authors declare that they have no competing interests.

Clinical and dental photography is an acquired skill. It is learned, developed and practised at post-graduate level by medical photographers across the U.K. But where does the medical photography profession stand in terms of transmitting slowly acquired skills to a wider clinical audience? If some or all skills need to be passed on, how and to whom should they be taught? This paper considers how dental practitioners may benefit from training in specific aspects of clinical photography and suggests a tried and tested model of instructional design for a clinical photography course utilised and implemented for undergraduate dental students studying at the University of Leeds. The authors found a course of this nature demanded skills and theoretical understanding of cognitive architecture beyond the purview of most clinical field experts. A collaborative approach to instructional design between a field expert and clinical educator was implemented, which allowed the design of a dental photography course that worked effectively by linking new to prior knowledge.

This article reviews the use of mirrorless systems in medical photography, based on the author's experience using Sony mirrorless systems. It is not aimed at being an in depth comparative technical review but aims to discuss the technology as a viable alternative to the digital single lens reflex (DSLR) when documenting the most common subjects a medical photographer will face.

Background: Parental supervised brushing (PSB) when initiated in infancy can lead to long-term protective home-based oral health habits thereby reducing the risk of dental caries. However, PSB is a complex behaviour with many barriers reported by parents hindering its effective implementation. Within the UK, oral health advice is delivered universally to parents by health visitors and their wider teams when children are aged between 9 and 12 months. Nevertheless, there is no standardised intervention or training upon which health visitors can base this advice, and they often lack the specialised knowledge needed to help parents overcome barriers to performing PSB and limiting sugary foods and drinks.Working with health visitors and parents of children aged 9-24 months, we have co-designed oral health training and resources (Health Visitors delivering Advice in Britain on Infant Toothbrushing (HABIT) intervention) to be used by health visitors and their wider teams when providing parents of children aged 9-12 months with oral health advice.The aim of the study is to explore the acceptability of the HABIT intervention to parents and health visitors, to examine the mechanism of action and develop suitable objective measures of PSB., Methods/design: Six health visitors working in a deprived city in the UK will be provided with training on how to use the HABIT intervention. Health visitors will then each deliver the intervention to five parents of children aged 9-12 months. The research team will collect measures of PSB and dietary behaviours before and at 2 weeks and 3 months after the HABIT intervention. Acceptability of the HABIT intervention to health visitors will be explored through semi-structured diaries completed after each visit and a focus group discussion after delivery to all parents. Acceptability of the HABIT intervention and mechanism of action will be explored briefly during each home visit with parents and in greater details in 20-25 qualitative interviews after the completion of data collection. The utility of three objective measures of PSB will be compared with each other and with parental-self reports., Discussion: This study will provide essential information to inform the design of a definitive cluster randomised controlled trial., Trial Registration: There is no database for early phase studies such as ours., Competing Interests: Ethical approval and research permissions have been successfully obtained from the Research Ethics Committee (17/YH/0301) (Yorkshire & The Humber - Leeds East Research Ethics Committee), Health Research Authority (IRAS ID 230315) and NIHR CRN Portfolio Adoption.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.