Protocol for 'Seal or Varnish' (SoV) trial: A randomised controlled trial to measure the relative cost and effectiveness of pit and fissure sealants and fluoride varnish in preventing dental decay

Background Dental caries remains a significant public health problem, prevalence being linked to social and economic deprivation. Occlusal surfaces of first permanent molars are the most susceptible site in the developing permanent dentition. Cochrane reviews have shown pit and fissure sealants (PFS) and fluoride varnish (FV) to be effective over no intervention in preventing caries. However, the comparative cost and effectiveness of these treatments is uncertain. The primary aim of the trial described in this protocol is to compare the clinical effectiveness of PFS and FV in preventing dental caries in first permanent molars in 6-7 year-olds. Secondary aims include: establishing the costs and the relative cost-effectiveness of PFS and FV delivered in a community/school setting; examining the impact of PFS and FV on children and their parents/carers in terms of quality of life/treatment acceptability measures; and examining the implementation of treatment in a community setting. Methods/design The trial design comprises a randomised, assessor-blinded, two-arm, parallel group trial in 6–7 year old schoolchildren. Clinical procedures and assessments will be performed at 66 primary schools, in deprived areas in South Wales. Treatments will be delivered via a mobile dental clinic. In total, 920 children will be recruited (460 per trial arm). At baseline and annually for 36 months dental caries will be recorded using the International Caries Detection and Assessment System (ICDAS) by trained and calibrated dentists. PFS and FV will be applied by trained dental hygienists. The FV will be applied at baseline, 6, 12, 18, 24 and 30 months. The PFS will be applied at baseline and re-examined at 6, 12, 18, 24, and 30 months, and will be re-applied if the existing sealant has become detached/is insufficient. The economic analysis will estimate the costs of providing the PFS versus FV. The process evaluation will assess implementation and acceptability through acceptability scales, a schools questionnaire and interviews with children, parents, dentists, dental nurses and school staff. The primary outcome measure will be the proportion of children developing new caries on any one of up to four treated first permanent molars. Discussion The objectives of this study have been identified by the National Institute for Health Research as one of importance to the National Health Service in the UK. The results of this trial will provide guidance on which of these technologies should be adopted for the prevention of dental decay in the most susceptible tooth-surface in the most at risk children

A Fair Process [Letter]

[Letter

Clinical audit of children's missed dental appointments in a city-wide salaried community dental service in relation to guidance on when to suspect child maltreatment

Children's missed healthcare appointments may be an alerting feature of neglect so it is essential that concerns are shared with other professionals. The aim of this clinical audit was to investigate the management of missed dental appointments for children in a city-wide salaried community dental service. Standards for communication with (a) the family, (b) other professionals and (c) child protection referral to social care were developed using NICE Clinical Guidance 89: When to suspect child maltreatment and the British Society of Paediatric Dentistry's policy document on dental neglect. Information collected from a random sample of 100 clinical records included communication actions within six months of a missed appointment and dental outcome. After reporting the first-cycle (C1) results, procedures were modified and staff training provided. Sampling and data collection were repeated annually for two further cycles (C2, C3). Communication standards were not fully met in any cycle. The missed appointment rate was 11–12 per cent. An initial small increase in interprofessional communication, including two child protection referrals to social care, was achieved in C2 together with a reduction in unresolved dental outcomes. However, omissions still occurred and improvements were not maintained in the third cycle, demonstrating insufficient consistency to ensure the protection of vulnerable children

Validation of undergraduate clinical data by electronic capture (barcode)

Assessment of clinical activity is common in dental schools. An audit project to confirm that dental undergraduate clinical activity recorded by electronic data capture is an accurate representation of the clinical case entry is reported. A printout of clinical activity for a period of a week was generated retrospectively and used to identify case notes. Activity recorded in the case notes was compared with the computer printout. All discrepancies were noted. A total of 125 patient files with 270 barcoded items of treatment were retrieved; 29 of 78 (37.1%) paediatric and 23 of 47 (48.9%) orthodontic cases had discrepancies between the case notes and the computer entry. However,some items recorded in the notes do not require barcoding and vice versa. When these were accounted for, only 19 items of treatment appeared in the notes that should have been barcoded,a 7% shortfall in recording of clinical activity. The barcode system is an accurate and reliable way of recording undergraduate clinical activity

Repairing traumatic injuries in immature non-vital teeth

Mineral Trioxide Aggregate (MTA) is a dental material which allows a one-visit apexification and is considered an effective alternative to calcium hydroxide. It is important for the whole dental team to understand the clinical techniques used and the materials involved