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

Abstract

BackgroundIn 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/DesignThis 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.DiscussionThe 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 registrationISRCTN24958829 (date of registration: 27 September 2013), Current protocol version: 5.0.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-015-1010-9) contains supplementary material, which is available to authorized users.

Dental RECUR Randomized Trial to Prevent Caries Recurrence in Children

“…All staff received training in good clinical practice, trial protocol, and diagnostic criteria for baseline caries assessments. Each site had investigator site files and participant case report forms (protocol details in Pine et al 2015).…”

“…We developed a psychosocial intervention-the Dental RECUR Brief Negotiated Interview for Oral Health (DR-BNI)-to be delivered to parents of children who have had a dental extraction of primary teeth (Pine et al 2015). DR-BNI can be delivered by dental nurses (assistants) and is designed to develop shared understanding with parents through communication about adopting healthier behaviors to reduce recurrence of caries in their children.…”

Participation of paediatric patients in primary dental care before and after a dental general anaesthetic

“…Motivational interviewing is an alternative method of delivering prevention with a greater potential for positive dental health behaviour changes, alongside a structured prevention programme, than more traditional methods (Pine et al 2015 ). Therefore, reorientation of dental undergraduate and postgraduate teaching on prevention, with a focus on motivational interviewing, may help with future efforts to drive the desired behaviour change amongst children and their families.…”

Comparative Studies of some Chemical and Micronutrient Contents in three Sprouted Samples of Bambaranut (Vinga subterranean [l] verdc.) Landraces

“…Deficiency of calcium, especially over a long time, can lead to oestoporosis in which the bone deteriorates and there is an increased risk of fractures. Consumption of a well-balanced diet can provide all the necessary nutrients and help prevent calcium deficiency (26).…”