A new primary dental care service compared with standard care for child and family to reduce the re-occurrence of childhood dental caries (Dental RECUR): study protocol for a randomised controlled trial

Background: In England and Scotland, dental extraction is the single highest cause of planned admission to the hospital for children under 11 years. Traditional dental services have had limited success in reducing this disease burden. Interventions based on motivational interviewing have been shown to impact positively dental health behaviours and could facilitate the prevention of re-occurrence of dental caries in this high-risk population. The objective of the study is to evaluate whether a new, dental nurse-led service, delivered using a brief negotiated interview based on motivational interviewing, is a more cost-effective service than treatment as usual, in reducing the re-occurrence of dental decay in young children with previous dental extractions. Methods/Design: This 2-year, two-arm, multicentre, randomised controlled trial will include 224 child participants, initially aged 5 to 7 years, who are scheduled to have one or more primary teeth extracted for dental caries under general anaesthesia (GA), relative analgesia (RA: inhalation sedation) or local anaesthesia (LA). The trial will be conducted in University Dental Hospitals, Secondary Care Centres or other providers of dental extraction services across the United Kingdom. The intervention will include a brief negotiated interview (based on the principles of motivational interviewing) delivered between enrolment and 6 weeks post-extraction, followed by directed prevention in primary dental care. Participants will be followed up for 2 years. The main outcome measure will be the dental caries experienced by 2 years post-enrolment at the level of dentine involvement on any tooth in either dentition, which had been caries-free at the baseline assessment. Discussion: The participants are a hard-to-reach group in which secondary prevention is a challenge. Lack of engagement with dental care makes the children and their families scheduled for extraction particularly difficult to recruit to an RCT. Variations in service delivery between sites have also added to the challenges in implementing the Dental RECUR protocol during the recruitment phase. Trial registration: ISRCTN24958829 (date of registration: 27 September 2013), Current protocol version: 5.0

Co-creating strategies and actions to tackle oral health-related stigma

Stigma is the greatest barrier faced by people experiencing social exclusion when accessing healthcare. Recent WHO framework for meaningful engagement of people living with noncommunicable diseases [1] builds on different types of evidence to acknowledge and empower people through participation in related health processes that address the systemic inequalities and inequities experienced around the globe. This framework sets up principles, enablers, and actions for the equitable inclusion of individuals in co-creating healthcare services and policy. Eliminating stigma is one of the core enablers for operationalizing this framework with one of the actions focused on reviewing and monitoring engagement work to prevent stigmatization and discrimination.Oral health-related stigma has been identified and defined as a unique health stigma that harms people and groups with oral health that differs from the prevailing cultural norms [2, 3, 4]. Health-related stigmas affect individuals by discouraging access to services, impairing adherence to treatment, diminishing mental health and social resources, and impacting quality of life. Social signalling through the media, social networks, advertising, and other sources gives rise to Western cultural ideals of straight white teeth as synonymous with health, wealth and social status (5). Even minor irregularities such as mild spacing or normal racial pigmentation were cause for concern in the PPI group who have shared their insights on this topic. However, despite the ubiquity of oral health-related stigma in society, there is a paucity of research in the dental literature that explores the concept of oral health stigma and no published literature that explores attempts to destigmatise differences in oral health [2].An increasing concern is stigma consciously and unconsciously perpetrated by dental health professionals and/or oral health researchers towards patients also highlighted in the paper by Doughty et al [2] and others [5]. This hands-on workshop will further expand on the ideas put forwards in this paper in an opening interactive segment that will use visual images to stimulate discussion and unpack clinicians’ and oral health researchers’ perspectives of oral health-related stigma. It will then use snapshot presentations by expert speakers to share patients’ perceptions of oral health related stigma. This will showcase research that has prioritised listening and learning from patients and people with lived experience of social exclusion across the globe. The group will then work together in the final segment of the session to identify and co-create strategies and actions to reduce professional and oral health perpetuated oral-health stigma. 3. Sponsorship : proposal submitted to Global Oral Health Inequalities Research Network (GOHIRN) and Behavioural, Epidemiologic and Health Services Research Group (BEHSR) 4.Learning Objectives4.1.Increase knowledge on oral health-related stigma. 4.2.Critical understand of the effects and experiences of oral health-related stigma of vulnerable groups.4.3.Critical reflect on strategies to tackle stigma in dental health services that prioritise involvement of patients and people with lived experience.5.ParticipantsCorresponding organizer: Andrea Rodriguez Organisers: Andrea Rodriguez (University of Dundee, UK); Janine Yazdi-Doughty (University of Liverpool, UK); Barry Gibson (University of Sheffield, UK); Vanessa Muirhead (Queen Mary University of London, UK)Chair Moderator : Vanessa Muirhead (VM)6.Speakers: Janine Yazdi-Doughty (JD); Barry Gibson (BG); Andrea Rodriguez (AR)Speaker’s titles for short presentations:-‘Conceptualizing Oral Health-related Stigma’ (JD)-‘Life after tooth loss: efforts to preserve a sense of self’ (BG)-‘Perspectives of vulnerable groups in Scotland and Brazil on the consequences of stigma’ (AR) The Hands on Workshop will involve four moments:Section ComponentsTiming Chair/speaker initialsWelcoming participantsIntroduction/background4 minutesVMBreakout workshop 1Group discussion: Practitioners’ understanding of oral health-related stigma 15 - 20 minutesWhole group Presenting consequences of stigma from the patient’s perspective (PPI members)5 minutesJDWhole group feedback 10 minutesVMPresentations Conceptualizing Oral Health-related Stigma7 minutesJDLife after tooth loss: efforts to preserve a sense of self7 minutesBGPerspectives of vulnerable groups in Scotland and Brazil on the consequences of stigma’7 minutes ARBreakout workshop 2Strategies/actions for engagement work to tackle stigma15 minutes Whole group Feedback from participants 10 minutesVM Opportunity for questions 5 minutesVM, AR, JDi.Welcoming participants (VM)ii.20 min breakout workshop group discussion comprised as follows:o1. ‘Practitioners’ understanding of oral health-related stigma’ and group discussion o2. Presenting the Consequences of stigma from the patient’s perspective followed by group feedback. iii.Speakers’ short presentations + Q&amp;A with participants (JD, BG, and AR)oConceptualizing Oral Health-related Stigma (JD)oLife after tooth loss: efforts to preserve a sense of self (BG)oPerspectives of vulnerable groups in Scotland and Brazil on the consequences of stigma’ (AR)iv.30 min breakout workshop group discussion 3. o20 mins discussion ‘Strategies/actions for engagement work to tackle stigma’ o10 min group feedback. TOTAL Time: 90 minutesKey words : Stigma, Inclusion Oral Health, Empowerment, Patient Engagement. References1.World Health Organization (2023). WHO framework for meaningful engagement of people living with noncommunicable diseases, and mental health and neurological conditions. Global Coordination Mechanism Secretariat for NCDs, 10 May 2023, 73p. https://www.who.int/publications/i/item/9789240073074 2.Doughty, J., M. E. Macdonald, V. Muirhead and R. Freeman (2023). "Oral health-related stigma: Describing and defining a ubiquitous phenomenon." Community Dentistry and Oral Epidemiology n/a(n/a).3.Moore D, Keat R. Does dental appearance impact on employability in adults? A scoping review of quantitative and qualitative evi-dence. Br Dent J. 2020.4.Seehra J, Newton JT, DiBiase AT. Bullying in schoolchildren – its relationship to dental appearance and psychosocial implications: an update for GDPs. Br Dent J. 2011;210:411- 4155.Yuvaraj, A., V. S. Mahendra, V. Chakrapani, E. Yunihastuti, A. J. Santella, A. Ranauta and J. Doughty (2020). "HIV and stigma in the healthcare setting." Oral Diseases 26: 103-111.<br/

All-cause and cause-specific mortality in US adults with periodontal diseases: A prospective cohort study

AimThis prospective cohort study investigated the association between periodontal diseases (PDs) and all-cause and cause-specific mortality.Materials and MethodsWe utilized adult participants recruited from six National Health and Nutrition Examination Survey cycles (1999–2014) and linked mortality data from the National Death Index up to December 2019. Baseline clinical periodontal examinations were performed by trained and calibrated examiners. All-cause and cause-specific mortality was modelled through multivariable Cox proportional hazards and Fine–Gray models to account for competing risks. All models were adjusted for demographic and lifestyle variables, clinical measurements and comorbidities.ResultsOverall, 15,030 participants were included, with a median length of follow-up of 9 years. Risk of all-cause mortality was 22% greater in people with PD than the control group (adjusted hazard ratio [HR]: 1.22, 95% confidence interval [CI]: 1.12–1.31). Risks of mortality by cardiovascular diseases (CVD), respiratory disease and diabetes were highest in participants with severe PD (CVD—sub-distribution HR [SHR]: 1.38, 95% CI: 1.16–1.64; respiratory—SHR: 1.62, 95% CI: 1.07–2.45; diabetes—SHR: 1.68, 95% CI: 1.12–2.53).ConclusionsSevere PD is associated with all-cause and cause-specific mortality among US adults after multivariable adjustment

Additional file 1: of A new primary dental care service compared with standard care for child and family to reduce the re-occurrence of childhood dental caries (Dental RECUR): study protocol for a randomised controlled trial

Modified dental contemplation ladder. (DOCX 91 kb