Evaluation of a national complex oral health improvement programme: a population data linkage cohort study in Scotland
Objectives Child dental caries is a global public health challenge with high prevalence and wide inequalities. A complex public health programme (Childsmile) was established. We aimed to evaluate the reach of the programme and its impact on child oral health.Setting Education, health and community s...
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BMJ Publishing Group
2020-11-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/11/e038116.full |
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| author | Jamie BR Kidd Alex D McMahon Andrea Sherriff Wendy Gnich Ahmed Mahmoud Lorna MD Macpherson David I Conway |
| author_facet | Jamie BR Kidd Alex D McMahon Andrea Sherriff Wendy Gnich Ahmed Mahmoud Lorna MD Macpherson David I Conway |
| author_sort | Jamie BR Kidd |
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| description | Objectives Child dental caries is a global public health challenge with high prevalence and wide inequalities. A complex public health programme (Childsmile) was established. We aimed to evaluate the reach of the programme and its impact on child oral health.Setting Education, health and community settings, Scotland-wide.Interventions Childsmile (national oral health improvement programme) interventions: nursery-based fluoride varnish applications (FVAs) and supervised daily toothbrushing, community-based Dental Health Support Worker (DHSW) contacts and primary care dental practice visits—delivered to the population via a proportionate universal approach.Participants 50 379 children (mean age=5.5 years, SD=0.3) attending local authority schools (2014/2015).Design Population-based individual child-level data on four Childsmile interventions linked to dental inspection survey data to form a longitudinal cohort. Logistic regression assessed intervention reach and the independent impact of each intervention on caries experience, adjusting for age, sex and area-based Scottish Index of Multiple Deprivation (SIMD).Outcome measures Reach of the programme is defined as the percentage of children receiving each intervention at least once by SIMD fifth. Obvious dental caries experience (presence/absence) is defined as the presence of decay (into dentine), missing (extracted) due to decay or filled deciduous teeth.Results 15 032 (29.8%) children had caries experience. The universal interventions had high population reach: nursery toothbrushing (89.1%), dental practice visits (70.5%). The targeted interventions strongly favoured children from the most deprived areas: DHSW contacts (SIMD 1: 29.5% vs SIMD 5: 7.7%), nursery FVAs (SIMD 1: 75.2% vs SIMD 5: 23.2%). Odds of caries experience were markedly lower among children participating in nursery toothbrushing (>3 years, adjusted OR (aOR)=0.60; 95% CI 0.55 to 0.66) and attending dental practice (≥6 visits, aOR=0.55; 95% CI 0.50 to 0.61). The findings were less clear for DHSW contacts. Nursery FVAs were not independently associated with caries experience.Conclusions The universal interventions, nursery toothbrushing and regular dental practice visits were independently and most strongly associated with reduced odds of caries experience in the cohort, with nursery toothbrushing having the greatest impact among children in areas of high deprivation. |
| format | Article |
| id | doaj-art-8774bb3c652047ee9472b359b54ccd6e |
| institution | Kabale University |
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| language | English |
| publishDate | 2020-11-01 |
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| series | BMJ Open |
| spelling | doaj-art-8774bb3c652047ee9472b359b54ccd6e2024-11-25T08:10:08ZengBMJ Publishing GroupBMJ Open2044-60552020-11-01101110.1136/bmjopen-2020-038116Evaluation of a national complex oral health improvement programme: a population data linkage cohort study in ScotlandJamie BR Kidd0Alex D McMahon1Andrea Sherriff2Wendy Gnich3Ahmed Mahmoud4Lorna MD Macpherson5David I Conway6School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, UKSchool of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, UK1 School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UKSchool of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, UKPublic Health Scotland, Edinburgh, UKSchool of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, UK1 School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UKObjectives Child dental caries is a global public health challenge with high prevalence and wide inequalities. A complex public health programme (Childsmile) was established. We aimed to evaluate the reach of the programme and its impact on child oral health.Setting Education, health and community settings, Scotland-wide.Interventions Childsmile (national oral health improvement programme) interventions: nursery-based fluoride varnish applications (FVAs) and supervised daily toothbrushing, community-based Dental Health Support Worker (DHSW) contacts and primary care dental practice visits—delivered to the population via a proportionate universal approach.Participants 50 379 children (mean age=5.5 years, SD=0.3) attending local authority schools (2014/2015).Design Population-based individual child-level data on four Childsmile interventions linked to dental inspection survey data to form a longitudinal cohort. Logistic regression assessed intervention reach and the independent impact of each intervention on caries experience, adjusting for age, sex and area-based Scottish Index of Multiple Deprivation (SIMD).Outcome measures Reach of the programme is defined as the percentage of children receiving each intervention at least once by SIMD fifth. Obvious dental caries experience (presence/absence) is defined as the presence of decay (into dentine), missing (extracted) due to decay or filled deciduous teeth.Results 15 032 (29.8%) children had caries experience. The universal interventions had high population reach: nursery toothbrushing (89.1%), dental practice visits (70.5%). The targeted interventions strongly favoured children from the most deprived areas: DHSW contacts (SIMD 1: 29.5% vs SIMD 5: 7.7%), nursery FVAs (SIMD 1: 75.2% vs SIMD 5: 23.2%). Odds of caries experience were markedly lower among children participating in nursery toothbrushing (>3 years, adjusted OR (aOR)=0.60; 95% CI 0.55 to 0.66) and attending dental practice (≥6 visits, aOR=0.55; 95% CI 0.50 to 0.61). The findings were less clear for DHSW contacts. Nursery FVAs were not independently associated with caries experience.Conclusions The universal interventions, nursery toothbrushing and regular dental practice visits were independently and most strongly associated with reduced odds of caries experience in the cohort, with nursery toothbrushing having the greatest impact among children in areas of high deprivation.https://bmjopen.bmj.com/content/10/11/e038116.full |
| spellingShingle | Jamie BR Kidd Alex D McMahon Andrea Sherriff Wendy Gnich Ahmed Mahmoud Lorna MD Macpherson David I Conway Evaluation of a national complex oral health improvement programme: a population data linkage cohort study in Scotland BMJ Open |
| title | Evaluation of a national complex oral health improvement programme: a population data linkage cohort study in Scotland |
| title_full | Evaluation of a national complex oral health improvement programme: a population data linkage cohort study in Scotland |
| title_fullStr | Evaluation of a national complex oral health improvement programme: a population data linkage cohort study in Scotland |
| title_full_unstemmed | Evaluation of a national complex oral health improvement programme: a population data linkage cohort study in Scotland |
| title_short | Evaluation of a national complex oral health improvement programme: a population data linkage cohort study in Scotland |
| title_sort | evaluation of a national complex oral health improvement programme a population data linkage cohort study in scotland |
| url | https://bmjopen.bmj.com/content/10/11/e038116.full |
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