Dental RECUR clinical trial to prevent re-occurrence of caries in children

Cynthia Pine, Pauline Adair, Girvan Burnside, Louise Brennan, L Sutton, R T Edwards, V Ezeofor, Saldos Albadri, Morag Curnow, Chris Deery, Marie-Therese Hosey, J Willis-Lake, J Lynn, J Parry, FSL Wong

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Abstract

OBJECTIVES: to determine the efficacy of a dental nurse-delivered intervention, the Dental Recur Brief Negotiated Interview for Oral Health (DR-BNI), in reducing the re-occurrence of dental caries in children who had a primary tooth extracted two years previously. METHOD: Two-arm, multi-centre randomised controlled trial (RCT), with blinded outcome assessment. 12 Centres in the UK; n=241, 5-7 year-old children scheduled to have primary teeth extracted. Test intervention (n=119): DR-BNI informed by motivational interviewing (MI). 30-minute structured conversation with parents led by trained dental nurses. Forward focus to prevent caries in future. Preventive goals agreed, review appointment made with general dental practice (GDP). GDP advised to treat child as high caries-risk. Control intervention (n=122): conversation about future eruption of permanent teeth, advised attend GDP as usual. Baseline: mean dmft 6.8 in DR-BNI group, 6.3 in control, median 5 teeth extracted, mainly under general anaesthesia. RESULTS: Final dental assessments by a single examiner visiting 189 schools two years after intervention; 193 (80%) of 241 children examined. 62% in control group developed new caries in teeth that were caries free or unerupted at baseline. In the test group, this was 44%, a significant reduction (p=0.021). The odds of new caries experience occurring were reduced by 51% in the DR-BNI group compared to control. Relative risk: 29% decrease in the risk of new caries experience in the DR-BNI group compared to control. In a wide range of high caries risk children, this single, low cost, low intensity intervention was successful in significantly reducing the risk of new caries experience. CONCLUSION: this trial has implications for changing paediatric dental practice internationally. Training in, and implementation of, an MI-informed brief intervention provides opportunities for dental nurses to go beyond clinical prevention to facilitate behaviour change, and to support oral health improvements for high caries risk children.
Original languageEnglish
JournalJournal of Dental Research
Publication statusAccepted - 14 Oct 2019

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Tooth
Oral Health
Clinical Trials
Dental General Practices
Dental Assistants
Interviews
Motivational Interviewing
Deciduous Tooth
Tooth Eruption
Dental Caries
General Anesthesia
Appointments and Schedules
Arm
Randomized Controlled Trials
Parents
Outcome Assessment (Health Care)
Pediatrics
Costs and Cost Analysis
Control Groups

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Pine, C., Adair, P., Burnside, G., Brennan, L., Sutton, L., Edwards, R. T., ... Wong, FSL. (Accepted/In press). Dental RECUR clinical trial to prevent re-occurrence of caries in children. Journal of Dental Research.
Pine, Cynthia ; Adair, Pauline ; Burnside, Girvan ; Brennan, Louise ; Sutton, L ; Edwards, R T ; Ezeofor, V ; Albadri, Saldos ; Curnow, Morag ; Deery, Chris ; Hosey, Marie-Therese ; Willis-Lake, J ; Lynn, J ; Parry, J ; Wong, FSL. / Dental RECUR clinical trial to prevent re-occurrence of caries in children. In: Journal of Dental Research. 2019.
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abstract = "OBJECTIVES: to determine the efficacy of a dental nurse-delivered intervention, the Dental Recur Brief Negotiated Interview for Oral Health (DR-BNI), in reducing the re-occurrence of dental caries in children who had a primary tooth extracted two years previously. METHOD: Two-arm, multi-centre randomised controlled trial (RCT), with blinded outcome assessment. 12 Centres in the UK; n=241, 5-7 year-old children scheduled to have primary teeth extracted. Test intervention (n=119): DR-BNI informed by motivational interviewing (MI). 30-minute structured conversation with parents led by trained dental nurses. Forward focus to prevent caries in future. Preventive goals agreed, review appointment made with general dental practice (GDP). GDP advised to treat child as high caries-risk. Control intervention (n=122): conversation about future eruption of permanent teeth, advised attend GDP as usual. Baseline: mean dmft 6.8 in DR-BNI group, 6.3 in control, median 5 teeth extracted, mainly under general anaesthesia. RESULTS: Final dental assessments by a single examiner visiting 189 schools two years after intervention; 193 (80{\%}) of 241 children examined. 62{\%} in control group developed new caries in teeth that were caries free or unerupted at baseline. In the test group, this was 44{\%}, a significant reduction (p=0.021). The odds of new caries experience occurring were reduced by 51{\%} in the DR-BNI group compared to control. Relative risk: 29{\%} decrease in the risk of new caries experience in the DR-BNI group compared to control. In a wide range of high caries risk children, this single, low cost, low intensity intervention was successful in significantly reducing the risk of new caries experience. CONCLUSION: this trial has implications for changing paediatric dental practice internationally. Training in, and implementation of, an MI-informed brief intervention provides opportunities for dental nurses to go beyond clinical prevention to facilitate behaviour change, and to support oral health improvements for high caries risk children.",
author = "Cynthia Pine and Pauline Adair and Girvan Burnside and Louise Brennan and L Sutton and Edwards, {R T} and V Ezeofor and Saldos Albadri and Morag Curnow and Chris Deery and Marie-Therese Hosey and J Willis-Lake and J Lynn and J Parry and FSL Wong",
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Pine, C, Adair, P, Burnside, G, Brennan, L, Sutton, L, Edwards, RT, Ezeofor, V, Albadri, S, Curnow, M, Deery, C, Hosey, M-T, Willis-Lake, J, Lynn, J, Parry, J & Wong, FSL 2019, 'Dental RECUR clinical trial to prevent re-occurrence of caries in children', Journal of Dental Research.

Dental RECUR clinical trial to prevent re-occurrence of caries in children. / Pine, Cynthia; Adair, Pauline; Burnside, Girvan; Brennan, Louise; Sutton, L; Edwards, R T; Ezeofor, V; Albadri, Saldos; Curnow, Morag; Deery, Chris; Hosey, Marie-Therese; Willis-Lake, J; Lynn, J; Parry, J; Wong, FSL.

In: Journal of Dental Research, 14.10.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Dental RECUR clinical trial to prevent re-occurrence of caries in children

AU - Pine, Cynthia

AU - Adair, Pauline

AU - Burnside, Girvan

AU - Brennan, Louise

AU - Sutton, L

AU - Edwards, R T

AU - Ezeofor, V

AU - Albadri, Saldos

AU - Curnow, Morag

AU - Deery, Chris

AU - Hosey, Marie-Therese

AU - Willis-Lake, J

AU - Lynn, J

AU - Parry, J

AU - Wong, FSL

PY - 2019/10/14

Y1 - 2019/10/14

N2 - OBJECTIVES: to determine the efficacy of a dental nurse-delivered intervention, the Dental Recur Brief Negotiated Interview for Oral Health (DR-BNI), in reducing the re-occurrence of dental caries in children who had a primary tooth extracted two years previously. METHOD: Two-arm, multi-centre randomised controlled trial (RCT), with blinded outcome assessment. 12 Centres in the UK; n=241, 5-7 year-old children scheduled to have primary teeth extracted. Test intervention (n=119): DR-BNI informed by motivational interviewing (MI). 30-minute structured conversation with parents led by trained dental nurses. Forward focus to prevent caries in future. Preventive goals agreed, review appointment made with general dental practice (GDP). GDP advised to treat child as high caries-risk. Control intervention (n=122): conversation about future eruption of permanent teeth, advised attend GDP as usual. Baseline: mean dmft 6.8 in DR-BNI group, 6.3 in control, median 5 teeth extracted, mainly under general anaesthesia. RESULTS: Final dental assessments by a single examiner visiting 189 schools two years after intervention; 193 (80%) of 241 children examined. 62% in control group developed new caries in teeth that were caries free or unerupted at baseline. In the test group, this was 44%, a significant reduction (p=0.021). The odds of new caries experience occurring were reduced by 51% in the DR-BNI group compared to control. Relative risk: 29% decrease in the risk of new caries experience in the DR-BNI group compared to control. In a wide range of high caries risk children, this single, low cost, low intensity intervention was successful in significantly reducing the risk of new caries experience. CONCLUSION: this trial has implications for changing paediatric dental practice internationally. Training in, and implementation of, an MI-informed brief intervention provides opportunities for dental nurses to go beyond clinical prevention to facilitate behaviour change, and to support oral health improvements for high caries risk children.

AB - OBJECTIVES: to determine the efficacy of a dental nurse-delivered intervention, the Dental Recur Brief Negotiated Interview for Oral Health (DR-BNI), in reducing the re-occurrence of dental caries in children who had a primary tooth extracted two years previously. METHOD: Two-arm, multi-centre randomised controlled trial (RCT), with blinded outcome assessment. 12 Centres in the UK; n=241, 5-7 year-old children scheduled to have primary teeth extracted. Test intervention (n=119): DR-BNI informed by motivational interviewing (MI). 30-minute structured conversation with parents led by trained dental nurses. Forward focus to prevent caries in future. Preventive goals agreed, review appointment made with general dental practice (GDP). GDP advised to treat child as high caries-risk. Control intervention (n=122): conversation about future eruption of permanent teeth, advised attend GDP as usual. Baseline: mean dmft 6.8 in DR-BNI group, 6.3 in control, median 5 teeth extracted, mainly under general anaesthesia. RESULTS: Final dental assessments by a single examiner visiting 189 schools two years after intervention; 193 (80%) of 241 children examined. 62% in control group developed new caries in teeth that were caries free or unerupted at baseline. In the test group, this was 44%, a significant reduction (p=0.021). The odds of new caries experience occurring were reduced by 51% in the DR-BNI group compared to control. Relative risk: 29% decrease in the risk of new caries experience in the DR-BNI group compared to control. In a wide range of high caries risk children, this single, low cost, low intensity intervention was successful in significantly reducing the risk of new caries experience. CONCLUSION: this trial has implications for changing paediatric dental practice internationally. Training in, and implementation of, an MI-informed brief intervention provides opportunities for dental nurses to go beyond clinical prevention to facilitate behaviour change, and to support oral health improvements for high caries risk children.

M3 - Article

JO - Journal of Dental Research

JF - Journal of Dental Research

SN - 0022-0345

ER -

Pine C, Adair P, Burnside G, Brennan L, Sutton L, Edwards RT et al. Dental RECUR clinical trial to prevent re-occurrence of caries in children. Journal of Dental Research. 2019 Oct 14.