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Conversation with dental nurse can reduce risk of further tooth decay in young children

 

Results from an NIHR-funded trial show that a single conversation with a trained dental nurse for families of children having teeth extracted can reduce the risk of further tooth decay by more than a quarter.

The Dental RECUR trial, funded by NIHR’s Research for Patient Benefit Programme, took place in 12 centres in the UK and involved over 200 families of five to seven-year-old children having baby teeth extracted in hospital. The results were published in the Journal of Dental Research.

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%).

Tooth decay is the single highest reason for children to be admitted to hospital, with 33,779 children aged nine or under admitted to hospital to have teeth extracted in 2017-18. 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 normally needs to be done under general anaesthetic.

Evidence also shows that children who have baby teeth taken out are much more likely to get decay again in their adult teeth. Research in this area suggests that people often know what has caused the tooth decay, but find it very difficult to change habits.

To tackle this problem, the research team at Salford Royal NHS Foundation Trust developed a ‘talking’ intervention and trained dental nurses to have conversations with parents of children who were having teeth extracted. They compared outcomes for these children with those who had been given standard advice about regular visits to the dentist.

The conversations with dental nurses focused on how families could prevent tooth decay in the future, helping them to choose goals that they felt they could achieve.

Senior Dental Nurse Louise Morris, who was involved in the study, 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 researchers checked the health of the children’s teeth two years later and asked their dentists about care provided. They found that nearly two thirds of children in both groups went back to the dentist.

However, the children whose families had not spoken to the specially trained dental nurses needed many more fillings. Children whose families had set their own dental health goals had significantly healthier teeth and had a 29% lower risk of having new tooth decay.

Trial lead Professor Cynthia Pine CBE, Consultant in Dental Public Health at Salford Care Organisation, said: '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.'

The research team have been invited by Health Education North West to develop their work into a training module for dental nurses in the NHS. They plan to make this available by early spring 2020.

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