Search PubMed⌕ Search

Biomedical subjects

A Blinkhorn

Publications and source records attributed to A Blinkhorn.

At least 19 recordsLinked to original sources
PubMed2006

The effectiveness of school dental screening: a cluster-randomized control trial.

Dental screening of children in schools is undertaken in many countries. There is no evidence that this activity is effective. The objective of our study was to determine if school dental screening of children reduces untreated disease or improves attendance at the population level. A four-arm cluster-randomized controlled trial was undertaken in the northwest of England. In total, 16,864 children aged 6-9 years in 168 schools were randomly allocated to 3 test groups, which received screening according to different models, and a control, which received no intervention. There were no significant differences in caries increment in the primary and secondary dentitions or in the proportions of children attending a dentist after screening between the control group and the 3 intervention arms. School dental screening delivered according to 3 different models was not effective at reducing levels of active caries and increasing attendance in the population under study.

Attitude to Health↗
PubMed2006

A survey of school dental screening practise in community dental services of England and Wales in 2003.

OBJECTIVE: To describe the school dental screening process in Community Dental Services across England and Wales. BASIC RESEARCH DESIGN: Cross-sectional study using a postal questionnaire. CLINICAL SETTING: Community Dental Services. PARTICIPANTS: Clinical Directors of Community Dental Services in England and Wales. MAIN OUTCOME MEASURES: Respondents answers about the objectives of school dental screening, criteria used for referring a child, methods of informing parents of screening results, and methods used to confirm subsequent dental attendance. RESULTS: The response rate for this study was 92.1%. Respondents identified dental registration (75.2%) and attendance at a dentist (82.9%) as objectives of school dental screening. Less than one third (29.5%) saw the activity as having a preventive role. Caries in the primary and secondary dentitions and soft tissue lesions were reported as key criteria for referral. Methods of follow-up of screened positive children differed and were often inadequate; approximately one third of respondents used a letter carried home by the child that did not allow parents to inform the CDS of action taken. Half of the respondents routinely collected data on the number of screened positive children who subsequently visit a dentist. CONCLUSIONS: School dental screening is delivered in a similar fashion throughout England and Wales but methods of informing parents of a positive screen and follow-up mechanisms for children with positive screens vary. Most school dental screening programmes do not collect sufficient data to evaluate the impact of their programmes on children's oral health.

Child↗
PubMed2003

Dental care of a child in pain -- a comparison of treatment planning options offered by GDPs in California and the North-west of England.

OBJECTIVE: To compare the treatment plans offered by general dental practitioners (GDPs) in the North-west of England (UK) and California (USA) in dealing with a child in pain. METHODS: A cross-sectional postal survey of a convenience sample of 135 UK and 170 USA GDP. These GDPs were asked to consider a case scenario of a 5-year-old child with pain from a lower first primary molar and to offer a treatment plan. The plan was to have three phases: immediate care, follow-up care and longer term preventive strategy. The influence of cost on treatment plans was also recorded. RESULTS: Response rates for the GDPs were 117 (86.6%) from the UK and 139 (81.8%) from the USA. The major differences in immediate care were as follows: 98% of Americans would take a radiograph, 41% would consider extraction, 37% would place a space maintainer and 4% would use general anaesthesia to extract a tooth. Comparable proportions for the English dentists were 20%, 21%, 2% and 40%. Later clinical options also showed differences: 39% of UK dentists would extract all first primary molars compared to only 1% of Americans. Eighty-eight per cent of USA dentists would place a nickel chrome crown compared to 4% of UK respondents. There were also differences in the longer term preventive measures. Greater proportions of American dentists would offer fluoride varnish (30%) and fluoride mouthrinse (37%). Comparable UK responses were 13% and 28%. Cost of care was only mentioned by 3% of UK dentists, whereas 70% of USA dentists mentioned cost as a factor in treatment planning. CONCLUSION: There were marked differences in the treatment of a child in pain between general practitioners in the UK and the USA. Further investigations are required to elucidate the reasons for these differences.

Anesthesia, General↗
PubMed2002

The fate of the carious primary teeth of children who regularly attend the general dental service.

OBJECTIVE: To describe the care and resultant outcomes of the carious primary teeth of children who regularly attend the General Dental Service (GDS). SETTING: Four districts in the North West of England SUBJECTS AND MATERIALS: A retrospective study of the case notes of 677 children who received their dental care from 50 general dental practitioners (GDPs). Each dentist must have had a minimum of 10 patients and a maximum of 20 patients whose care had been provided by the same dentist from or before the age of five to the age of 14. All of the children included in the study had a history of approximal caries. The outcomes of interest were extraction due to pain or sepsis, or exfoliation and whether or not a tooth had given rise to the prescription of a course of antibiotics. Teeth that did not have a history of extraction were assumed to have exfoliated naturally. Logistic regression models, taking into account the clustering of the teeth within patients, were fitted to compare the outcomes for restored and unrestored teeth according to size of lesion (one or two surface), age caries was first recorded and by tooth type. RESULTS: A total of 4,056 teeth had been either recorded as carious or had received an intervention of some kind. Some 44.1% (N=1,789) of these teeth were extracted, however only 475 (11.7%) were extracted due to pain or sepsis. Of the teeth with a documented history of caries or restoration and for which an outcome was recorded (N=3,145), most first (81.1%) and second (84.3%) carious primary molars were filled during their lifetime, but only 40.5% of primary carious anterior teeth were filled. The majority of carious primary teeth exfoliated naturally. There was no difference in the proportions of teeth extracted due to pain or sepsis whether a carious tooth was restored or left unrestored, either by cavity type or by tooth type, after controlling for age when caries was first recorded. There was also no difference in the number of filled or unfilled carious teeth that caused a course of antibiotics to be prescribed. CONCLUSIONS: Treatment by extraction was common, but GDPs restored the majority of carious primary molar teeth of their regularly attending child patients. The bulk of carious teeth exfoliated naturally irrespective of whether they were filled or not. The reasons for these findings require further investigation.

Adolescent↗
PubMed2002

Sex hormonal factors and chronic widespread pain: a population study among women.

OBJECTIVE: The observation of higher rates of chronic widespread pain, the cardinal feature of fibromyalgia, in women has led to hypotheses about the role of sex hormonal factors in the aetiology of symptoms. There is little available evidence from epidemiological studies on their importance or role. METHODS: A population postal survey was carried out involving 1178 female participants living in south-east Cheshire in the north-west of England. RESULTS: Amongst pre- and peri-menopausal women, the risk of chronic widespread pain was unrelated either to the length of the menstrual cycle or the usual length of period reported by participants. Risk was similar in current users and non-users of the oral contraceptive pill, and amongst users there was no relationship with duration of use. However, the reporting of chronic widespread pain showed a relationship with total score on a premenstrual symptom questionnaire. However, this relationship was explained by pain symptoms. Amongst post-menopausal women, reporting chronic widespread pain was not related to age at menopause. An increased (but non-significant) risk of chronic widespread pain was associated with current hormone replacement therapy (HRT), which may be a consequence of HRT being prescribed for menopausal symptoms. CONCLUSION: This study, conducted on a large unselected population, has not demonstrated an association between sex hormonal factors and chronic widespread pain.

Adolescent↗
PubMed2001

'What do our patients really want from us?': Investigating patients perceptions of the validity of the Chartermark criteria.

BACKGROUND: The 'restructuring' of the NHS over the last decade has demanded a 'market oriented' service more receptive to the needs and priorities of 'clients'receiving health care. These changes have been important to the provision of dental health care in which there has been a similar need to provide increasingly patient and market oriented services. One of the ways in which quality care has been assessed within NHS Trusts is through the national 'Chartermark' award, which identifies national centres of excellence in health care and research. AIM: The aim of this paper is to assess whether patients themselves considered the criteria identified by the Chartermark award important in the provision of good quality dental services METHOD: This is a pilot study consisting of a structured questionnaire conducted face-to-face with a 'convenience' sample of 46 patients. ANALYSIS: Data were inputted into SPSS and thematic analysis was conducted on the data. RESULTS: The Chartermark criteria relevant to patient involvement were divided into four main themes.The findings from this small pilot study suggest that in relation to dental care, although patients are interested in information on standards, performance and complaints, there is considerable disinterest in organisational and financial dimensions.

Awards and Prizes↗
PubMed2001

Matching dental practice board data to the health authority population register.

OBJECTIVE: To evaluate the process of matching Dental Practice Board (DPB) registration data to the health authority (HA) register for a defined locality. This included testing for the presence of socio-economic bias in the postcodes held in the DPB data sets and to determine if patients travelling to obtain primary dental care would have an effect on the matching process at health authority level. BASIC RESEARCH DESIGN: All 21 general dental practitioners in Ellesmere Port, South Cheshire gave written consent for the DPB to provide files of their registered patients to the health authority. The registered patients were electronically matched against residents in the HA register in a four stage process. Testing for the presence of a socio-economic bias in the postcodes included in the DPB data set was undertaken by constructing frequency distributions of the proportions of postcoded, and non or partially postcoded DPB records by Super Profiles Lifestyle group. A chi square test was used to test for significant differences. The extent of patients travelling to access primary dental care was assessed by comparing the proportions of registered patients of under 6 years, 25-60 years and those aged 65+ who lived outside South Cheshire Health Authority yet obtained their GDS care within Ellesmere Port. MAIN OUTCOME MEASURES: Out of a total of 39,474 records, 458 (1.2%) were duplicates. Some 35,447 (90.9%) of DPB records could be matched to those contained in the HA register. No significant (chi2 =10.85, df=9, P=0.27) socio-economic difference was found in the proportions of DPB records originally with, and without postcodes by Super Profiles Lifestyle group. Some 1,688 (47.3%) of the unmatched subjects were resident in health authorities other than South Cheshire and therefore could not be expected to be found in the HA register. Nearly 90% of children under 6 years registered with an Ellesmere Port GDP were South Cheshire residents, compared to approximately 85% of adults of working age and older adults. CONCLUSIONS: In this locality DPB data could be matched to the HA register with a reasonable degree of success. However, because of the time taken to clean and make the data sets compatible, the methodology used is inappropriate for routine use. In this locality no socio-economic bias could be found in the records with missing postcodes in the DPB data set. Patients travelling to access dental care would have little influence on the matching process at health authority level in this locality, irrespective of the age group under study.

Adult↗
PubMed2000

Dental caries, contact with dental services and deprivation in young children: their relationship at a small area level.

OBJECTIVE: To measure the relationship between tooth decay, contact with dental services and deprivation at electoral ward level. SETTING: The study was carried out in 1998 in Ellesmere Port in the North West of England. SUBJECTS AND MATERIALS: All children younger than six years resident in Ellesmere Port registered with GDS services and those using CDS services were matched against the HA population register to identify unregistered children. Rates for children aged 3-5 years 'in contact' with primary dental care services, whether CDS or GDS, were calculated at ward level. One calibrated examiner examined all 5-year-old children in Ellesmere Port and dmft scores were calculated at ward level. Ward deprivation was measured using the Jarman score. Bivariate linear regressions at ward level were performed in turn between: dmft and Jarman score; rates for 3-5-year-olds in contact with dental services and Jarman score; and dmft and rates for 3-5-year-olds in contact with dental services. RESULTS: A significant linear relationship was observed between dmft and Jarman score (P=0.02, R2 = 0.43). Significant inverse relationships were found between rates for 3-5-year-olds in contact with dental services and Jarman score (P=0.001, R2 = 0.67), and also between dmft and rates for 3-5-year-olds in contact with dental services (P=0.002, R2 = 0.65). CONCLUSIONS: A strong inverse relationship was found between dental caries and contact with primary dental care services at electoral ward level. This relationship needs to be explored over a wider geographical area to establish if it is consistent and independent of deprivation.

Child Health Services↗
PubMed2000

Socioeconomic and geographical influences on primary dental care preferences in a population of young children.

OBJECTIVE: To compare the socioeconomic profiles of children registered in the GDS, with those using the CDS services and unregistered children. Secondly to examine the effects of socioeconomic status on travelling to access primary dental care, and finally to map out the location of unregistered children in relation to primary dental care services. SETTING: The study was carried out in 1998 in Ellesmere Port in the North West of England. SUBJECTS AND MATERIALS: The study population was all children younger than 6 years who used primary dental care services in, or were residents of, Ellesmere Port. The study population was categorized into those registered with a GDS dentist, those using CDS services and those unregistered by matching GDS and CDS data to the HA population register. Socioeconomic status was measured using the Super Profiles geodemographic classification. The relationship between service preferences and travelling to access primary dental care with socioeconomic status were compared using cross-tabulations and chi square tests. RESULTS: There was a significant socioeconomic trend evident in the use of dental services. Two thirds of those using CDS services came from the most deprived area types. Of those who were unregistered half lived in the most deprived area types compared with one third of those registered with the GDS. Those who travelled into Ellesmere Port to access primary dental care were significantly more likely to live in an affluent area. Unregistered patients were homogeneously spread across the town. CONCLUSIONS: The ability to match GDS and CDS data to the HA population register is essential to understand how dental services are used by the local population. Children from deprived areas are more likely to use the CDS and a service local to their homes, therefore primary dental care services for deprived communities have to be provided locally.

Case-Control Studies↗
PubMed2000

Predicting population dental disease experience at a small area level using Census and health service data.

BACKGROUND: Information on the dental disease patterns of child populations is required at a small area level. At present, this can be provided only by expensive whole population surveys. The aim of this study was to evaluate the ability of Census data combined with health service information to provide estimates of population dental disease experience at the small area level. METHOD: Clinical dental data were collected from a large cross-sectional survey of 5-year-old children. A preliminary series of bivariate linear regression analyses were undertaken at ward level with the mean number of decayed, missing or filled teeth per child (dmft) as the dependent variable, and the Census and health service and lifestyle variables suspected of having a strong relationship with dmft as independent variables. This was followed by fitting a multiple linear regression model using a stepwise procedure to include independent variables that explain most of the variability in the dependent variable dmft. RESULTS: All deprivation indicators derived from the Census showed a highly significant (p<0.001) bivariate linear relationship with ward dmft. The Jarman deprivation score gave the highest R2 value (0.45), but the Townsend index (R2=0.43) and the single Census variable 'percentage of households with no car' (R2 = 0.42) gave very similar results. The health and lifestyle indicators also showed highly significant (p<0.001) linear relationships with dmft. The R2 values were generally much lower than the deprivation-related Census variables, with the exception of the percentage of residents who smoked (R2 = 0.42). None of the health or lifestyle variables was included in the final dental disadvantage model. This model explained 51 per cent of the variability of ward dmft. CONCLUSIONS: The results demonstrate the strong relationship between dental decay and deprivation, and all of the commonly used measures of deprivation exhibited a similar performance. For this population of young children health and health services shelf data did not improve on the ability of deprivation-related Census variables to predict population dental caries experience at a small area level.

Child, Preschool↗
PubMed2000

Sentinel practices in dentistry: a preliminary evaluation.

The objectives of this study were to compare the socioeconomic make-up and the dental caries and dental treatment patterns of a general dental practice (GDP) population of five-year-old children with those of the total resident population of five-year-old children in a specific locality, and, secondly, to examine the process of gathering information on oral healthcare needs in primary dental care. The study was set in Halton, North Cheshire. Data were collected retrospectively from the patient records of four GDP sentinel' practices using a common data abstraction form. The socioeconomic profiles of the GDP population and the 1995/6 NHS child dental health survey population were compared using the Super Profiles geodemographic classification by plotting frequency distributions. The dmft of each population was compared by calculating 95% confidence intervals. The GDP population showed a slight over-representation in the more affluent groupings of the Super Profiles Lifestyle categories and a more dramatic under-representation in two of the more deprived groupings. The confidence intervals for dt and dmft of the GDP data did not include the mean figures produced by the NHS survey, indicating a significant difference at the P < 0.05 level. These differences may be accounted for by the differences in the socioeconomic make-up of the two populations. Local practice policies on patient selection may also have a consequential effect on population disease estimates derived from primary dental care. Data on population disease experience from primary dental care could only be produced by hand-sorting through patient records, which was time-consuming and inefficient. Standardised electronic systems will need to be developed to make GDP data-collection a viable proposition. Information from primary dental care has the potential to make a major contribution to locality oral health needs assessment and it should be seen as being complementary to information gathered from epidemiological surveys.

Child, Preschool↗
PubMed2000

Comparing the ability of different area measures of socioeconomic status to segment a population according to caries prevalence.

OBJECTIVE: to compare the ability of different area based indicators of socio-economic status to segment a population of 5-year-old children according to caries prevalence. BASIC RESEARCH DESIGN: The study population consisted of all 5-year-old children in seven districts in the North West Region of England who were examined in whole population surveys during the 1995/6 NHS epidemiological survey. This population was segmented according to caries prevalence by market penetration analyses using Super Profiles and the ONS geodemographic classifications, Jarman and Townsend (at ward and ED level) deprivation indices, the single census variables of unemployment and percentage of households without a car, and also the school that the children attended. Lorenz curves were plotted from the outputs of the penetration analyses. MAIN OUTCOME MEASURES: Overall caries prevalence for the population was 55.3%. All the indicators provided a very similar picture. Large differences were detected between the highest and lowest market penetration rankings for each indicator, ranging from 42.5% for the ONS geodemographic classification to 31.4% for the Townsend index at enumeration district level. However, for each indicator, the fall between these two extremes was gradual. This picture was represented by the similar effectiveness scores of around 10% for each indicator which were derived from the Lorenz curves. Each indicator could identify approximately 30% of those with disease in the topmost 25% of the total population in the penetration ranking. When the analysis was restricted to those children with severe disease (dmft> or =5) a similar picture was found, however the effectiveness score increased to 19%. CONCLUSIONS: There was a remarkably consistent inequitable distribution of population disease prevalence found between deprived and affluent area types, irrespective of what measuring instrument was used. Although there was a large difference in prevalence (dmft>0 and dmft>5) found between deprived and affluent areas, there was a gradual fall between the two extremes. This gradual fall has implications for oral health improvement strategies.

Child, Preschool↗
PubMed2000

The utility of anonymised postcoded registration data provided by the Dental Practice Board.

OBJECTIVE: To evaluate the completeness of the postcodes held in the data sets of the Dental Practice Board (DPB), and the use of the location of the dental practice at which a patient is registered, as a proxy for the location of their residential address. BASIC RESEARCH DESIGN: A cross-sectional evaluation of anonymised person-based registration data held by the DPB. The study population was all children aged under 6 years registered with a dentist in the North West Region of England. The percentage of records that could be geo-referenced from the postcodes contained within the DPB's data sets was calculated. For all records which could be geo-referenced, the proportion of children who lived in the same health authority as the dental practice they were registered with was also calculated. MAIN OUTCOME MEASURES: A total of 193,466 children in the North West Region were registered with a general dental practitioner (GDP). Of this total 117,607 (60.8 percent) could be geo-referenced from the contents of the postcode field. However, there was considerable variation in the match across the region. The majority of children lived in the same health authority as the dental practice they were registered with. It was noticeable that a greater proportion (28.5 percent) of residents registered with a dentist located within the boundaries of Manchester Health Authority were not Manchester residents. CONCLUSIONS: Due to a significant proportion of missing postcodes, data presently held by the DPB cannot be used to calculate accurate registration rates at a small area level. Using the dental practice location as a proxy for residential address is inaccurate at health authority level, especially for large conurbations. This inaccuracy will increase at small area level. Registration data held by DPB are a potentially valuable information source, but before this information can be of use to commissioners the problem of poor postcode coverage will need to be resolved.

Child, Preschool↗
PubMed1999

The effects of socioeconomic status and dental attendance on dental caries' experience, and treatment patterns in 5-year-old children.

OBJECTIVE: To compare the dental caries' experience and treatment received by 5-year-old children registered with a GDP. DESIGN: Retrospective case note review of all 5-year-old children registered with seven GDPs. SETTING: The study was carried out in 1996/7 in Wirral and North Cheshire in the north west of England. SUBJECTS AND MATERIALS: Clinical, demographic and attendance data were collected from each practice using a common data abstraction form. Subjects were categorised according to regular/irregular attenders, and into five groups ranging from affluent to deprived using the Super Profiles geodemographic classification. The relationships between disease experience, treatment, attendance and socioeconomic status were compared using cross-tabulations, t-tests and multiple linear regression. RESULTS: The dental records of 430 5-year-old children were available for analysis. Irregular attenders had significantly higher dmft, dt and mt, and fewer filled teeth. Only 29% of disease experience of regular attenders was treated by restoration. Both socioeconomic status and visiting behaviour exerted significant independent effects on dmft, but dental attendance alone had a significant effect on ft. CONCLUSIONS: Significant inequalities remain in the disease experience and service use of young children. Regularly attending children have less than a third of their diseased teeth restored. Consensus is needed across the profession on the care of the diseased deciduous dentition.

Child, Preschool↗
PubMed1996

Dental health services research: what is it and does it matter?

Dentists working in the National Health Service offer an efficient service. However, changes in medical and dental technologies require all of us to monitor the effectiveness of both established and new treatments. Our clinical practices should become 'research laboratories' and we must grasp this opportunity to keep dentistry at the forefront of investigations into clinical care.

Cost-Benefit Analysis↗
PubMed1996

A method of estimating tooth life expectancy.

One of the most important outcome measures for dental services is the increase in tooth life expectancy which is brought about by the interventions provided. Thus, a convenient and accurate index of tooth survival is critical both to clinical decision making and to more general assessments of public dental health policies. This paper describes a simple method of approximating tooth life expectancy (TLE). The method is based on the assumption that tooth survival follows a simple declining exponential function. Assuming a constant mortality rate, TLE is the integral of the survival function, expressed as S(t) = e-mu t, where t is time and mu the constant mortality rate. Using 3-year tooth-specific mortality rates for 491 subjects aged 50 years or more, tooth-specific life expectancies for the population as a whole where found to range from 27 years for upper canines to 71 years for lower incisors. Individuals with a mean periodontal attachment loss greater than 4 mm and people on low incomes had significantly lower tooth life expectancies than their periodontally fit and more wealthy counterparts. This technique can be used to obtain disease-specific or intervention-specific tooth life expectancies. Thus, gains in TLE for individuals with different oral, social and behavioural characteristics can be calculated. The declining exponential approximation of tooth life expectancy has the potential to become a powerful tool in the evaluation of dental services and treatments.

Cuspid↗