Professor Cynthia Pine

‘Talking intervention’ cuts risk of tooth decay in children

Nearly a quarter of five-year-olds in the UK experience tooth decay.  Children from the most deprived areas have more than twice the level of decay (34%) than those from the least deprived (14%).

In some areas, it is even higher – in Salford and Oldham it is as many as 51 per cent, for instance.

33,779 children aged nine or under were admitted to hospital to have teeth extracted because of tooth decay in 2017-18. It is the single highest reason for children to be admitted to hospital.

As well as causing pain, sleepless nights and days of missed school and work for children and their families, each extraction costs the NHS around £1,000.

And children who need to have baby teeth taken out are much more likely to get decay again in their adult teeth.

That is why a new research study highlighting a novel ‘talking intervention’ to improve children’s dental health is so important. It aimed to find out if families could be supported to prevent future decay in their children.

This trial was led from Salford Royal NHS Foundation Trust by the Chief Investigator Professor Cynthia Pine CBE who is Consultant in Dental Public Health at Salford Care Organisation, Professor of Dental Public Health at Queen Mary University of London, and Honorary Consultant at Barts Health NHS Trust. It was funded by the National Institute for Health Research.

Professor Pine said:  ““This trial is important because we found that if we change how we talk to parents about prevention, their children go on to develop  many fewer cavities. The key is helping parents to choose one or two behaviours they feel they can change for their child, rather than us telling parents what to do, that makes the difference.”

What did researchers find?

In the Dental RECUR clinical trial researchers found that a single therapeutic conversation by trained dental nurses with families of children having teeth extracted has led to a 29 per cent reduction in risk of those children having new tooth decay two years later compared to control children.

Why is this important?

The highest cause of planned admission to hospital for children under 11 is to have teeth taken out, usually under a general anaesthetic. While surgery deals with the immediate problem, it cannot stop future decay. The causes are still there. These are having too many sugary snacks and drinks, and not brushing teeth with fluoride toothpaste night and morning. Families miss out on preventive care if they only take their child to the dentist when they have toothache. People often know what has caused the tooth decay but find it too difficult to change habits. The advice that we give as health professionals can seem out-of-reach. How we give that advice often does not take account of the challenges families face.

What did the researchers do?

The research team developed a ‘talking’ intervention and trained dental nurses to have this therapeutic conversation with parents of children coming to have their children’s teeth taken out. The Dental Recur Brief Negotiated Interview, DR-BNI is based on two methods – motivational interviewing (MI) and behaviour change techniques.  The randomised clinical trial, Dental RECUR, aimed to find out if this could lower the chances of tooth decay coming back in children who had baby teeth extracted two years before.

The trial ran in 12 centres in the UK with over 200 families of five to seven-year-old children having baby teeth extracted. Families had an equal chance of having the DR-BNI or a control conversation about new adult teeth.

DR-BNI focuses on how families can prevent tooth decay in the future. Rather than telling families what to do, they choose goals they feel they can do, like swapping sweet drinks for unsweetened ones or brushing their child’s teeth at bedtime.

At the end of the 30-minute DR-BNI, the dental nurse made a review appointment with general dental practice (GDP). The team wrote to the GDP with the goals parents had agreed and asked the dentist to treat the child as at high risk to new tooth decay.

For the control families, we advised them to visit the dentist as usual.

Independently, the team checked the health of the children’s teeth two years later in their schools and asked the GDPs about care provided.  They found that nearly two thirds of children in both groups went back to the dentist. They had very similar high levels of clinical preventive treatment, but the control children had needed many more fillings. DR-BNI children had significantly healthier teeth and had reduced the risk of having new tooth decay by 29% compared to the control children.

What are the implications for dental practice?

In a wide range of high risk children across the UK, this single, low cost, low intensity intervention was successful in significantly reducing the risk of new decay experience. This trial has implications for changing paediatric dental practice nationally. Training in, and implementation of, this MI-informed brief intervention, DR-BNI provides opportunities for dental nurses to go beyond clinical prevention to facilitate behaviour change, and to support oral health improvements for children at high risk of developing tooth decay.

What happens next?

The research team have been invited by Health Education North West to develop the research DR-BNI into a training module for dental nurses in the NHS. They plan to have the DR-BNI available by early Spring 2020.

In order to provide this care, dental nurses need to attend a one-day training programme, practise the skills in their own practice and have an assessment to become an accredited facilitator. The conversation with parents of these high-risk children takes about 30 minutes.

Senior Dental Nurse at Pendleton Gateway, Salford, Louise Morris, was one of those involved in the study. She said: “I find that if we give lots of information and guidance at once it can be overwhelming for parents. In this trial, we helped families choose one or two actions. It might be to help brush their child’s teeth at night, or stop giving a sugary snack at bedtime. It became their goal not ours and they could see a way forward.”

The practice is now planning to set up a dental nurse-led clinic to help families with preventing further dental decay.

Read the research paper in the Journal of Dental Research.

Photograph by Bill Knight www.knightsight.uk