Child oral health-related quality of life following treatment under dental general anaesthetic (DGA)

Data sources: PubMed, EMBASE, Web of Science, CINAHL and the Cochrane Library. Study selection: Two independent reviewers selected studies which employed validated QoL instruments, Early Childhood Oral Health Impact Scale (ECOHIS) and the Child Oral Health-Related Quality of Life (COHRQoL) questionnaire to evaluate the change in child oral health-related quality of life (OHRQoL), following dental treatment under general anaesthesia (DGA) for caries. Data extraction and synthesis: Risk of bias was assessed using the Cochrane collaboration tool. A meta-analysis was conducted, dividing studies based on the OHRQoL measure used. Results: Twenty-two research articles were included in the review, which included 12 studies employing each of the two OHRQoL measures. Risk of bias in the included studies varied considerably. An overall improvement in OHRQoL was identified in all studies following DGA. The mean difference in scores post-treatment for ECOHIS and COHRQoL were 1.62 (95% CI 1.52-1.71; P <0.00001; I2 = 0%) and 0.86 (95% CI 0.74-0.99; P <0.00001; I2 = 0%), respectively, with medium to large effect sizes. There was no evidence of heterogeneity. Conclusions: Treatment under DGA significantly improved the OHRQoL of children, as reported by their parents. The authors suggest that studies of longer than three months are required to assess whether these changes are sustained in the long-term

Oral health-related quality of life following dental treatment under general anaesthesia for early childhood caries - a UK-based study.

Objective To assess parental reports of changes in oral health-related quality of life (OHRQoL) of young children in the UK with early childhood caries (ECC) following dental treatment under general anaesthesia (DGA). To compare the impact of oral rehabilitation (OR) and extraction-only (Exo) treatment approaches on this. Methods Data were collected using the proxy reported components of the Child Oral Health-Related Quality of Life (COHRQoL®) questionnaire: the Parent-Caregivers Perceptions questionnaire (P-CPQ) and Family Impact Scale (FIS), from a convenience sample of parents of children receiving DGA at a UK Paediatric Dental Department. Mean scores and prevalence impacts were compared pre- and postoperatively with mean change score and effect sizes calculations. Results Seventy-eight parents were recruited (51 children undergoing OR, 27 Exo) with 6 lost to follow-up (92.3%). Following treatment, changes in mean P-CPQ and FIS scores were statistically significant (P < 0.0001) with medium to large effect sizes (0.45–1.39). The differences in change scores between the two treatment approaches were not statistically different. Conclusion DGA for young children with early childhood caries resulted in substantial improvements in parent's ratings of their child's OHRQoL and of the impact on their families. Larger cohort studies are needed to validate these preliminary findings

The impact of dental caries on children and young people: What they have to say?

Background: Dental caries affects 60-90% of children across the world and is associated with a variety of negative impacts. Despite its ubiquity, there has been surprisingly little exploration of these impacts from the child's perspective. Aim: The aim was to allow children to describe the impact of dental caries on their daily lives and to describe the terminology they used. Design: Children, aged 5-15 years, with caries experience were purposively sampled from primary and secondary care dental clinics. Focus groups (n = 5) and in-depth interviews (n = 16) were recorded and transcribed verbatim. Data analysis took a narrative approach, and themes were derived from the data using framework analysis. Results: Pain was the main theme to emerge. Within this, three subthemes were identified: impacts related to pain, strategies adopted to reduce pain, and emotional aspects resulting from pain. A second theme was also identified relating to the aesthetic aspects of caries. Conclusion: Children as young as 5 years of age were able to competently discuss their experiences of dental caries. Participants reported a number of impacts affecting various aspects of their lives. These will be incorporated into the future development of a caries-specific measure of oral health-related quality of life

A scoping review of the uses of the care index in children

Objective: To conduct a scoping review of literature to describe how the care index (CI) and restorative index (RI) are used in child populations and to determine whether they are fit for purpose. Basic research design: Scoping review conducted using the Arksey and O’Malley (2005) framework. Method: Electronic and manual literature searches (1980–2015) were conducted. Titles and abstracts were screened, full-texts of potential studies were reviewed two reviewers extracted data independently, followed by data charting and summarising. Results: Out of 104 articles meeting all criteria, most were cross-sectional (92%), and 56% were conducted in UK and Brazil. Most commonly (63%) studies used CI and RI to obtain epidemiological data on dental care levels. Of the studies that defined CI and RI, most used and specified the standard definition. The CI and RI scores varied either due to patient related factors such as age, gender or dental care related factors including, cost of treatment and method of provider remuneration. Conclusion: Overall, it is recommended that future studies should clearly state the definitions and thresholds used to obtain CI and RI, which would enable comparison between communities and allow temporal trends to be studied. Additionally, deriving separate CI and RI scores for groups based on caries extent would help to highlight inequalities in the provision of care. Further research is needed to explore the applicability of CI and RI to changing approache

‘I would rather be having my leg cut off than a little needle’: A supplementary qualitative analysis of dentally anxious children’s experiences of needle fear

Fear of needles is common in childhood, with up to 50% being affected to some degree. In individuals who are dentally anxious, the prevalence may be as high as 91%. Fear of needles, and therefore intra-oral injections can have negative impacts on children’s quality of life and healthcare experiences, including a requirement for pharmacological methods to facilitate dental treatment. The aim of this study is to identify whether dentally anxious children report fear of injections and explore how these children experience a fear of needles in a dental setting. A supplementary analysis of interviews collected as part of two previous studies relating to children with dental anxiety. Five main themes were identified: feelings about needles; the nature of needle fear; the context of the fear, its consequences and how children tried to control the process. Children showed a desire to have control of their healthcare interventions, and wanted to trust the healthcare professionals giving the injections. There is evidence that children with dental anxiety also experience fear of needles, including intra-oral injections. Further primary qualitative research is needed to explore this topic in more depth and to design appropriate child centred interventions to reduce needle fear

Adolescent valuation of CARIES-QC-U: a child-centred preference-based measure of dental caries

Objectives: This study develops an adolescent value set for a child-centred dental caries-specific measure of oral health-related quality of life (OHRQoL) based upon CARIES-QC (Caries Impacts and Experiences Questionnaire for Children). This study develops a new approach to valuing child health by eliciting adolescent preferences and anchoring these onto the 1-0 full health-dead QALY (quality adjusted life year) scale using ordinal adult preferences.Methods: Two online surveys were created to elicit preferences for the CARIES-QC classification system. The first comprised best-worst scaling (BWS) tasks for completion by adolescents aged 11-16 years. The second comprised discrete choice experiment tasks with a duration attribute (DCETTO) for completion by adults aged over 18 years. Preferences were modelled using the conditional logit model. Mapping regressions anchored the adolescent BWS data onto the QALY scale using adult DCETTO values, since the BWS survey data alone cannot generate anchored values.Results: 723 adolescents completed the BWS survey and 626 adults completed the DCE(TTO )survey. The samples were representative of UK adolescent and adult populations. Fully consistent and robust models were produced for both BWS and DCETTO data. BWS preferences were mapped onto DCETTO values, resulting utility estimates for each health state defined by the classification system.Conclusion: This is the first measure with predetermined scoring based on preferences to be developed specifically for use in child oral health research, and uses a novel technique to generate a value set using adolescent preferences. The estimates can be used to generate QALYs in economic evaluations of interventions to improve children's oral health

‘Your teeth you are in control’

The use of cognitive behavioural therapy in reducing dental anxiety for paediatric patients </jats:p

Patients are asking about e-cigarettes. What do we tell them?

Provides an overview of what e-cigarettes are and who is using them. Considers the safety, quality and efficacy of e-cigarettes. Outlines the current and proposed legislation on e-cigarettes. Suggests advice for health professionals to give patients about e-cigarettes. Lists the questions to consider when deciding whether to permit or prohibit use of e-cigarettes on premises. Abstract E-cigarettes are electronic devices that deliver vaporised nicotine liquid into the lungs. Since the introduction of e-cigarettes in 2004, the market in the UK has rapidly expanded and increasingly people are asking health professionals about them. This article gives an overview of e-cigarettes, their use, their regulatory status and evidence for their safety, quality and efficacy. Advice about e-cigarettes for dental health professionals to give patients is provided, as well as the five questions, proposed by Action on Smoking and Health, to consider when deciding whether to permit or prohibit use of e-cigarettes on premises