Title: Comparison of a new with standard child and family primary care service to reduce the re-occurrence of childhood dental caries (DENTALRECUR Trial)
Funder: Department of Health and Social Care

Abstract: Background Dental extraction under General Anaesthetic (GA) is the most frequent reason for planned admission to hospital for children under 11. A minority suffer dental neglect and NICE recognises dental neglect as an indicator of general neglect. Hard-to-reach families may need tailored support as parents whose children develop new decay post-extraction can have low self efficacy. Researchers in US have developed successful parental interventions for childhood dental caries using Motivational Interviewing (MI). We are working with the US team, and families in Salford have informed the study design, the first in the UK, to evaluate the cost-effectiveness of a dental nurse-led intervention of extended MI on parental self efficacy of oral health-related behaviours to reduce recurrence of decay. Aims Primary Aim: To compare the costs and benefits of a new dental nurse-led service including motivational interviewing with a standard practice-based service in reducing the re-occurrence of dental decay in children who have had a previous primary tooth extraction for dental caries. Secondary Aims: 1) To compare the following outcomes of those assigned to the new and standard dental services: • parental self-efficacy to undertake dental health-related behaviours for their child; • parent-reported child behaviours of frequency of sugary foods and drinks and toothbrushing; • parental attitudes to child dental health and value of dental health-related behaviours, preventive or symptomatic use of dental services by the children. 2) To investigate the fidelity of the MI intervention Plan of Investigation Parents of children <7 years scheduled for primary tooth extraction for caries, will be invited to help evaluate a new dental service and randomly allocated to new service or usual care. Usual care: appointments sent for preventive care at dental practice New service: by dental nurse • 3 weekly visits one month post-operatively (MI to enhance parental self-efficacy and related to parental Stages of Change for oral health-related behaviours) delivered in the community in Children’s Centres • Follow up in practice with phone/text reinforcement • Fluoride varnish application • Recall 3 monthly in Year 1 • Dental examinations by examiner blind to group, at baseline,1 and 2 years post-intervention • Self-efficacy and behaviour measures • Cost-benefit health economic analysis???? ? Potential Impact In 2008/9, the Department of Health (England) reported that over 87,000 children/young people had hospital admissions due to caries, over 50,000 had GAs. Children having primary teeth extracted are significantly more likely to develop further decay and have their first permanent molars extracted. A new dental service that can reduce re-occurrence of dental decay has the potential to result in: reductions in re-attendance in hospital for tooth extraction; reduction of dental pain and lost days from school; improvements in child oral health and oral sepsis; identification of children at risk of neglect. This study addresses the NHS QIPP agenda (Quality, Innovation, Productivity and Prevention) by taking an innovative approach to reduce secondary care costs and oral heath inequalities.

Lay abstract: 1 in 2 children in Salford and Manchester aged 5 years has tooth decay. Many of those children have had a tooth extracted. Removal of teeth under general anaesthesia is the single most common reason for planned admission to hospital for children under 11. Children who have already had teeth extracted are at higher risk of further decay and extractions of permanent teeth in the future. Lack of attendance for regular dental care, despite obvious need, is recognised as neglect under national UK guidelines, and, in some cases, indicates that a child is at general risk of neglect. In our research, we have found that parents of children who have teeth extracted for tooth decay, by local/general anaesthic or sedation, are less likely to attend for regular dental care themselves and more likely to be afraid of dentists. They can experience uncertainty about whether to take their child for care and less likely to feel they can undertake preventive dental care. Working with Children Centre staff and parents, a new service has been designed recognising that these families face tough challenges, and deprivation can result in poor child dental health. The new service includes an introduction to dental care in local children’s centres and will use a new approach, Motivational Interviewing, to work with families. This type of service has been successfully researched in disadvantaged communities in the USA. We have talked to those US researchers to learn from their experience. Parents/guardians of children, under 7 years, who are booked for an extraction for tooth decay, will be invited to take part. They will be randomly allocated to either, usual follow-up care or to the new community-delivered, dental nurse-led service, an outreach from general dental practice. We will look at whether children develop new tooth decay 2 years later; also whether parents feel able to undertake positive dental health-related behaviours for their child.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: ORAL AND GASTROINTESTINAL