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Biomedical subjects

N B Pitts

Publications and source records attributed to N B Pitts.

At least 55 records · Page 3Linked to original sources
PubMed2000

The dental caries experience of 14-year-old children in the United Kingdom. Surveys coordinated by the British Association for the Study of Community Dentistry in 1998/99.

DESIGN: This paper reports the results of standardised clinical caries examinations of 121.550 14-year-old children from across the United Kingdom, Jersey and the Isle of Man. These 1998/99 coordinated surveys are the latest in a series which seeks to monitor the dental health of children and to assess the delivery of dental services. METHOD: The criteria and conventions of the British Association for the Study of Community Dentistry were used. Representative samples were drawn from participating health authorities and boards and caries was diagnosed at the caries into dentine (D3) threshold using a visual method without radiography or fibreoptic transillumination. RESULTS: These demonstrated, once again, a wide variation in prevalence across the United Kingdom, with mean values for D3MFT for the current English regional offices (of the National Health Service) and the other UK countries ranging from 1.17 in West Midlands to 3.65 in Northern Ireland. The mean value for D3MFT across the United Kingdom was 1.76 (D3T=0.59, MT=0.15, FT=1.02). Overall, 54% of children had evidence of caries experience at the dentinal level (D3MFT>0), although the means ranged between 43% (South East) and 78% (Northern Ireland). The mean D3MFT for those with disease at this threshold was 3.24. Trends over time demonstrate an improvement of 10% in overall D3MFT for Great Britain since 1994/95, compared to the 21% seen over the previous four year period. Over recent years the overall trend in this age group seems to be towards lower values. However, there has been no improvement in mean MT since 1994/95, while FT and care index have fallen. The number of fillings provided in 1998/99 and thus the care index, remains low, on average across the UK, only 58% of the dentinal caries experience identified by survey examinations of permanent teeth was seen as fillings (range in individual districts and boards: 34% to 83%). CONCLUSION: Taken together, these findings demonstrate the continuing need for more effective preventive strategies and treatment services for this important age group.

Adolescent↗
PubMed1999

The dental caries status of Scottish adolescents reported to be regular attenders. Initial results from a primary dental care based research network.

AIM: To investigate the caries status of, and the delivery of care to, a group of regularly attending adolescent dental patients. To conduct research in primary dental care. A subsidiary aim was to compare the caries status of this sample to population samples. SETTING: General dental practices across Scotland. DESIGN: A 3-year cohort study. SUBJECTS: 41 volunteer general dental practitioners and 616 adolescent patients (mean age = 12.1 years at baseline) defined by the practitioners as 'regular' attenders. RESULTS: All practices remained in the study. 403 subjects were seen at both baseline and final examination and 329 were examined at all 4 annual examinations. The mean D3MFT (dentine caries threshold) was 1.8 at baseline and 3.9 at the final examination, three years later. Of the 541 subjects seen at baseline 62% had experienced either restored or unrestored dentinal caries. Thirty-four percent of all those examined at baseline had all the unrestored dentinal caries. The majority of the disease was to be found in the molar teeth, particularly the first permanent molars. The provision of sealants was relatively high with 85% of subjects having at least one sealed tooth by the final examination. Although disease levels were related to socio-economic status, the Care Index was not. CONCLUSIONS: The 'regularly attending' subjects had a better normative level of dental health than their peers in the Scottish population. However, wide variation was found. The project also demonstrated the feasibility of undertaking research in partnership with general dental practitioners.

Adolescent↗
PubMed1999

The use of magnification in general dental practice in Scotland--a survey report.

OBJECTIVES: This study had two aims, first, to quantify the level of the use of magnification in general dental practice in Scotland and second, to determine the current and potential areas of clinical use of magnification by general dental practitioners. METHODS: A questionnaire was sent to all general dental practitioners in Scotland with a Health Board list number (n = 1790). The questionnaire asked the practitioners about their experience of magnification and their opinions on possible areas for clinical use. An information sheet and a prepaid envelope were included with the questionnaire. RESULTS: One thousand two hundred and eighty (72%) of the dentists replied to the questionnaire. Nine percent of the respondents routinely used magnification. The level of routine use of magnification by practitioners increased with time since qualification. The suggested areas of clinical use of magnification by all the respondents were crown and bridge work, diagnosis and radiography. The routine users of magnification had a more positive view of magnification than non-users. CONCLUSIONS: Routine use of magnification was associated with the length of time the practitioner had been qualified and the attendance at a course at which magnification was discussed. The perceived uses of magnification depended on the experience of the practitioner with magnification. It was considered suitable for all clinical procedures except orthodontics and prosthodontics.

Attitude of Health Personnel↗
PubMed1999

Deprivation and dental caries status of 5-year-old children in Scotland.

OBJECTIVES: The aim of this study was to investigate the relationship between the dental caries status of 5-year-old children in Scotland and deprivation, as assessed by the Carstairs score and its DEPCAT categories, which are composite descriptors of socio-economic status. METHODS: Anonymous records, including postcode sector of residence, from the 1995/96 Scottish Health Board's Dental Epidemiological Programme 5-year-old survey were linked though a multi-stage process to their corresponding Carstairs scores and DEPCAT categories. The data were analysed to investigate the relationship between d3t, mt, ft, d3mft, proportion 'free' of caries experience and socio-economic status for Scotland. RESULTS: When analysed by DEPCAT the mean d3mft ranged from 1.48 for children resident in the most affluent postcode areas (DEPCAT 1) to 4.87 for those in DEPCAT 7. The mean d3mft from the 1995/96 survey of 5-year-old children in Scotland was 2.93. For the percentage 'free' of caries experience (d3mft = 0) the findings in this study ranged from 62.4% (DEPCAT 1) to 19.8% (DEPCAT 7). The d3t and mt components of d3mft and mean d3mft showed a strong positive association with increasing deprivation. The proportion of 5-year-olds experiencing decay was also significantly associated with a more deprived Carstairs score. The f component showed no association with deprivation. The Care Index (ft/d3mft x 100%) ranged from 10.8% (DEPCAT 1) to 2.9% (DEPCAT 7). CONCLUSIONS: There was a striking association between increasing deprivation and increasing caries experience. Children from the most deprived areas had significantly more untreated decay and missing teeth. In a population with low levels of restorative intervention, no association was found between deprivation and the amount of restorative care received by Scottish 5-year-old children.

Chi-Square Distribution↗
PubMed1999

Developments in caries diagnosis and their relationship to treatment decisions and quality of care. ORCA Saturday Afternoon Symposium 1997.

This symposium report evaluates the achievements made in caries diagnostic research since the previous symposium held in 1992. The symposium aimed at presenting the state of the art of caries diagnostic methods, on presenting the links between caries diagnosis and subsequent treatment decisions and their effect on the treatment outcomes, particularly the quality of dental care. The variation among dentists in diagnosing (small) caries lesions and in treatment decision making is considerable. This has been explained by the imperfection of caries decision making tests, but also by making incorrect treatment decisions due to incorrect or partial understanding of diagnostic test parameters. Meta-analyses into the performance of caries diagnostic tests revealed that the available quantitative methods are very promising. It was concluded that these methods had high correlations with lesion depth. They were considered suitable to monitor small changes in lesions. Many obstacles have been experienced in attempting to transfer the outcomes of diagnostic research into clinical practice and it was concluded that caries diagnosis researchers should co-operate with manufacturers to introducing valid new diagnostic tools to the market. Main research priorities for the coming 10 years are to conduct cost-effectiveness and cost-utility studies of caries diagnostic tools, to continue to review the performances of diagnostic tests, to transfer diagnostic knowledge and experience to the general practitioners particularly by constructing evidence-based clinical guide-lines, to study the relationship between diagnosis and treatment decision, and to assess the effect of diagnostic and treatment decisions on the outcome of care.

Cost-Benefit Analysis↗
PubMed1999

The reliability of two methods of utility assessment in dentistry.

OBJECTIVE: The objective of this study was to investigate the modification of two utility assessment techniques (visual analogue scale and daily time trade-off) used in medicine to the dental setting, with a focus on their test-retest reliability and ease of use. BASIC RESEARCH DESIGN: The study involved a postal questionnaire survey which incorporated a dental visual analogue scale (DVAS) to assess utility values for 12 specified tooth states, and a specifically designed instrument, the dental freetime trade-off (DFTO) to assess utility of the participants' current dental health state. PARTICIPANTS: A total of 582 regularly attending adolescent dental patients were sent the questionnaire. A further 100 of those who fully completed the relevant sections of the questionnaire were sent a repeat questionnaire to facilitate assessment of test-retest reliability. RESULTS: A final response rate of 74.7% was achieved with the mean age of respondents being 17 years. Fifty per cent of those sent a repeat questionnaire for the purposes of reliability assessment returned the questionnaire. Test-retest reliability of both utility assessment techniques appeared acceptable. Spearman correlation coefficients for the dental freetime trade-off (DFTO) and the dental visual analogue scale (DVAS) were (0.67 and 0.83 respectively. Promising results, in terms of utility values, were elicited from the DVAS whilst utility values elicited using the DFTO were highly skewed. CONCLUSIONS: The newly developed modification to the daily time trade-off technique, the DFTO, showed a good level of test-retest reliability and ease of completion although the highly skewed utility results produced may indicate a design flaw. The DVAS however, appears to show promise, in terms of test-retest reliability, ease of completion and resultant utility values.

Adolescent↗
PubMed1999

The dental caries experience of 5-year-old children in the United Kingdom. Surveys co-ordinated by the British Association for the Study of Community Dentistry in 1997/98.

OBJECTIVE: This paper reports the results of standardised clinical caries examinations of 176,781 5-year-old children from across the United Kingdom. These 1997/98 co-ordinated surveys are the latest in a series which seek to monitor the dental health of children and to assess the delivery of dental services. METHOD: The criteria and conventions of the British Association for the Study of Community Dentistry were used. Representative samples were drawn from participating health authorities and boards and caries was diagnosed at the caries into dentine threshold using a visual method without radiography or fibre-optic transillumination. RESULTS: The results again demonstrated a wide variation in prevalence across the UK, with mean values for d3mft for the current English regions (of the National Health Service) and the other UK 'territories' ranging from 1.02 in the West Midlands to 2.92 in Northern Ireland. Mean d3mft across the UK was 1.68 (d3t = 1.18, mt = 0.26, ft = 0.23). Overall, 43% of children had evidence of caries experience (d3mft > 0), although the means ranged between 33% (West Midlands) and 63% (Northern Ireland). The distribution of caries was highly skewed. Thus the UK mean caries experience for those with disease was 3.94, as opposed to the overall mean of 1.68. Trends over time demonstrate a modest improvement of 8.7% in overall d3mft for Great Britain since 1995/96, compared to the small improvement seen two years ago and the deterioration seen four years previously. Both dt and mt have fallen while ft remained unchanged. The care index has increased in all but one region/territory (14% in 1997/8, compared to 12% in 1995/6). Regional/country means for 1997/8 ranged from 9-23%. This indicator has not, however, regained the levels seen in the past. CONCLUSION: There has been some improvement in the dental health of 5-year-old children. Overall, the provision of operative care for those with dentinal decay has also improved; however, significant groups remain within the population of 5-year-old children who have dental disease and who are in need of dental care.

Child, Preschool↗
PubMed1998

A longitudinal study of the dental care of adults in the general dental service in Scotland: the first 6 years, 1988-1994.

OBJECTIVE: To provide an overview of routine dental care for adults attending the general dental service in Scotland, in a more detailed manner than is currently possible from national data sets. DESIGN AND SETTING: Cohort study in the general dental service. SUBJECTS AND METHODS: The cohort consisted of 992 Scottish dentate adults who participated in the adult dental health survey of 1988, conducted by the Office of Population Censuses and Surveys. Details of subsequent treatment undertaken in the general dental service were provided by Dental Practice Division, Edinburgh. MAIN OUTCOME MEASURES: Production of patient-specific and tooth-specific data on dental attendance and treatment. RESULTS: 71% of the cohort attended at least once in the 6 years. Registration levels, following the introduction of the continuing care contract, reached 42-44%. Observed lapses in registration illustrate the changing membership of the relatively static level of registration year-on-year. Vulnerability to treatment of different tooth sites is illustrated graphically. CONCLUSIONS: Cohort studies provide valuable information on patterns of attendance and treatment needed for planning of dental health services. Growing computer power and increasing demands for management data may mean that future work of this nature can be more appropriately undertaken at the population level.

Adult↗
PubMed1998

The dental caries experience of 12-year-old children in the United Kingdom. Surveys coordinated by the British Association for the Study of Community Dentistry in 1996/97.

DESIGN: This paper reports the results of standardised clinical caries examinations of 129,941 twelve-year-old children from across the United Kingdom and the Isle of Man. These 1996/97 coordinated surveys are the latest in a series which seek to monitor the dental health of children and to assess the delivery of dental services. METHOD: The criteria and conventions of the British Association for the Study of Community Dentistry were used. Representative samples were drawn from participating health authorities and boards and caries was diagnosed at the caries into dentine (D3) threshold using a visual method without radiography or fibre-optic transillumination. RESULTS: These demonstrated once again a wide variation in prevalence across the United Kingdom, with mean values for D3MFT for the current English 'regions' (of the National Health Service) and the other UK 'territories' ranging from 0.66 in Thames South to 2.55 in Northern Ireland. The mean value for D3MFT across the United Kingdom was 1.13 (D3T = 0.48, MT = 0.10, FT = 0.54). Overall, 44% of children had evidence of caries experience at the dentinal level of detection (D3MFT > 0), although the means ranged between 31% (Thames South) and 72% (Northern Ireland). The mean D3MFT for those with disease at this threshold was 2.55. Trends over time demonstrate an improvement of 15% in overall D3MFT for Great Britain since 1992/93, compared to the 20% seen over the previous four year period. Over recent years the overall trend in this age group seems to be towards lower values. However, there has been no improvement in either mean DT or mean MT since 1992/93, while FT and care index have fallen. The number of fillings provided in 1996/97 and thus the care index, remain low, on average across the UK, only 48% of the dentinal caries experience identified by survey examinations of permanent teeth was seen as fillings (range in individual districts and boards: 27 to 76). CONCLUSION: Taken together, these findings demonstrate the continuing need for more effective preventive strategies and treatment services for this important age group.

Child↗
PubMed1998

Inequalities in children's caries experience: the nature and size of the UK problem.

OBJECTIVE: To discuss, as part of a symposium on 'Dental Care for the Disadvantaged Child', the inequalities in caries experience between a minority of children who demonstrate substantial dental disease and have, as a consequence, a considerable need for dental care and the majority who have little disease. METHOD: 1) Analysing data from regular NHS surveys of the dental health of British children in a number of defined age groups and examining socio-economic factors which operate and influence levels of dental caries to answer questions such as "Do we understand which children need and get appropriate dental care?". 2) Considering how appropriate future needs may be identified and addressed, and the gap between academic acceptance of new methodology and use by dental professionals may be narrowed. CONCLUSIONS: Integrated approaches to prevention should be focused on those children who have the greatest need in addition to the provision of appropriate, clinically effective, preventive and operative care for all children.

Adolescent↗
PubMed1997

Integrity, maintenance and caries susceptibility of sealed surfaces in adolescents receiving regular care from general dental practitioners in Scotland.

Pit and fissure sealants (sealants) are recognized as an effective caries preventive measure. The aim of this study was to assess the fate of occlusal surface sealants in a sample of 'regularly' attending adolescent patients (mean age 12.5 years at baseline) of 41 general dental practitioners, participating in a 3-year prospective clinical trial. A subsidiary aim was to compare the caries status of completely sealed surfaces with that of inadequately sealed surfaces over the same period. Baseline and three annual follow-up examinations were conducted by one trained and calibrated examiner under optimal conditions (dental chair, operating light, and compressed air). Sealed occlusal surfaces were evaluated for sealant type, sealant coverage, and caries status of the surface. Data for the initial and final year examinations were available for 402 subjects, who had 1377 sealants at baseline. Surfaces with optimal sealant coverage at baseline (n = 592) were significantly less likely to have become decayed (dentinal caries) or to have been restored by year 4 than surfaces with less than complete coverage (P < 0.001). Considering sealant maintenance during the study, 484 of the sealants were of optimal coverage (covered the fissure system) at the final examination. However, only 135 surfaces demonstrated evidence of maintenance by attaining optimal coverage. It is concluded that the fissure sealants in this sample may not have received the regular maintenance required to ensure full surface coverage and thus provide maximal caries protection, as inadequately sealed surfaces were more likely to decay than completely sealed surfaces.

Adolescent↗
PubMed1997

Diagnostic tools and measurements--impact on appropriate care.

The diagnosis of primary coronal caries should be seen as a complex process, comprising both detection and measurement phases, which enables clinicians, researchers and epidemiologists to make informed decisions about the management and prognosis of the disease process. The different diagnostic thresholds employed for measurements of caries experience can be viewed as an iceberg, a metaphor which demonstrates the ambiguity of the term "caries free" and which can also represent the differing management options appropriate for the care of different types of active and inactive lesions: NAC (No Active Care). PCA (Preventive Care Advised) and OCA (Operative Care Advised). There are considerable methodological difficulties in drawing valid comparisons between studies using incompatible criteria and simulations. However, it is apparent that no caries diagnostic tool in current clinical use fulfils all of the ideal criteria for measurements needed to plan and monitor appropriate care. Systems providing reliable serial measurements with which to assess future caries risk and present caries activity are urgently required as diagnostic tasks are becoming both more difficult and more important from the standpoint of long-term oral health. Existing diagnostic tools frequently rely on subjective judgements and provide only semi-quantitative measures insensitive to smaller lesions. In the future tools are needed which are objective, quantitative and which can provide acceptable compromises between sensitivity and specificity for a wide range of applications for individual patient care as well as for research and survey use. Key problem areas with existing tools include confusion in terminology and between caries assessments made by clinicians and epidemiologists as well as the lack of valid measurements relating to the activity of primary root caries and secondary caries. Deficiencies with current tools impact on the care of individuals by allowing false negative diagnoses of hidden occlusal dentine lesions and approximal cavities on the one hand, whilst generating some false positive diagnoses on sound surfaces leading to inappropriate decisions to restore on the other. At the population level, current conventional tools significantly underestimate overall caries experience. In future the adoption of more accurate and reliable methods would facilitate more effective preventive care and promote more appropriate restorative treatment decisions. Research in this area should focus for the next five years on diagnostic technologies which: 1) inform valid prospective caries risk assessments for different age groups, 2) can help to determine present caries activity and monitor lesion behaviour over time and 3) help identify methods which can implement existing and new research knowledge about diagnostic tools into clinical and research practice.

Age Factors↗
PubMed1997

The dental caries experience of 5-year-old children in the United Kingdom. Surveys coordinated by the British Association for the Study of Community Dentistry in 1995/96.

This paper reports the results of standardised clinical caries examinations of 172,659 five-year-old children from across the United Kingdom. These 1995/96 coordinated surveys are the latest in a series which seek to monitor the dental health of children and to assess the delivery of dental services. The criteria and conventions of the British Association for the Study of Community Dentistry were used. Representative samples were drawn from participating Health Authorities and Boards and caries was diagnosed at the caries into dentine (d3) threshold using a visual method without radiography or fibre-optic transillumination. The results demonstrated once again a wide variation in prevalence across the United Kingdom, with mean values for d3 mft for the current English regions (of the National Health Service) and the other UK territories ranging from 1.08 in the West Midlands to 3.04 in Northern Ireland. The mean value for d3mft across the United Kingdom was 1.84 (d3t = 1.32, mt = 0.30, ft = 0.22). Overall, 44 per cent of children had evidence of caries experience at the dentinal level of detection (d3mft > 0), although the means ranged between 33 per cent (West Midlands) and 63 per cent (Northern Ireland). Trends over time demonstrate a modest improvement of 6.7 per cent in overall d3mft for Great Britain since 1993/94, compared with the modest deterioration seen two years previously. Over recent years the overall trend in this age group seems to be flat, with evidence that there are minor deviations above and below a plateau value. However, there have been some changes. Both dt and the proportion with d > 0 have increased while ft and care index have fallen. The number of fillings provided in 1995/96, and thus the care index, remain low (UK mean care index = 12 per cent, regional/country means range from 8-20 per cent). These findings demonstrate the continuing need for more effective preventive and treatment services for this important age group.

Child, Preschool↗
PubMed1997

British Association for the Study of Community Dentistry (BASCD) coordinated National Health Service surveys of caries prevalence 1985/6-1995/6.

BACKGROUND: The British Association for the Study of Community Dentistry (BASCD) has, in conjunction with the National Health Service (NHS), been coordinating a series of epidemiological surveys of caries prevalence across various parts of the United Kingdom (UK) since 1985/6. THE TEAM: mounting and maintaining this programme of surveys has relied on the hard work and enthusiasm of many individuals working within the NHS from across the UK. The whole team is vital to the success of the programme and the Dental Epidemiology NHS "regional' Coordinators and "regional' trainers play a key role. THE SURVEYS: to date, seven surveys of 5-year-old children have been undertaken biennially since 1985/86, three surveys of 14-year-old children have been carried out at four intervals since 1986/87, while three surveys of 12-year-old children have been completed since 1988-89 at corresponding intervals. DIAGNOSTIC CRITERIA: the diagnostic criteria used in the programme developed from a 1983 consensus meeting and have slowly been developed with experience of how they were interpreted and used across the UK. TRAINING AND CALIBRATION: a number of national exercises have been held as the programme has developed which have improved our understanding of how criteria are being interpreted locally and have helped to improve the quality of the programme. QUALITY STANDARDS: include a trainer's pack for caries diagnosis, developed in 1992, which comprises 50 slides and a matching series of overhead transparencies. Guideline documents have also been produced for 1) sampling for surveys of child dental health and 2) for the statistical aspects of training and calibration of examiners for such surveys. CHALLENGES AND THE FUTURE: include incorporating the mechanics of the programme within the evolving purchaser/provider environment of the NHS and the inevitable tensions between disparate local and national needs. The results of the programme are to be disseminated more widely and are now incorporated into a number of formal NHS data systems used to plan and monitor public health and services. Updated data-entry and processing software is now being developed by BASCD for this programme and consideration is being given to modules to allow the extension of the programme to include public health assessments of orthodontic need and developmental defects of enamel.

Adolescent↗
PubMed1997

British Association for the Study of Community Dentistry (BASCD) diagnostic criteria for caries prevalence surveys-1996/97.

This paper outlines the current (1996/97) version of the diagnostic criteria relating to dental caries employed in the BASCD coordinated NHS Dental Epidemiology Programme. Some of the details as to how these criteria have evolved over the past 13 years. since the original guidelines publication (Palmer et al., 1984), can be found in a previous publication (Pitts, 1993) and in an earlier paper in this supplement (Pitts and Evans, 1997).

Adolescent↗
PubMed1997

British Association for the Study of Community Dentistry (BASCD) guidance on sampling for surveys of child dental health. A BASCD coordinated dental epidemiology programme quality standard.

The British Association for the Study of Community Dentistry (BASCD) is responsible for the coordination of locally based surveys of child dental health which permit local and national comparisons between health authorities and regions. These surveys began in 1985/86 in England and Wales, 1987/88 in Scotland and 1993/94 in Northern Ireland. BASCD has taken an increasing lead in setting quality standards in discussion with the NHS Epidemiology Coordinators of the Dental Epidemiology Programme. This paper comprises guidance on the sampling for these surveys.

Adolescent↗