Presentation is loading. Please wait.

Presentation is loading. Please wait.

Department of Health and Children Seminar April 2005 Lot 3 Fissure Sealing and the Targeted Approach to Service Delivery Oral Health Services Research.

Similar presentations


Presentation on theme: "Department of Health and Children Seminar April 2005 Lot 3 Fissure Sealing and the Targeted Approach to Service Delivery Oral Health Services Research."— Presentation transcript:

1 Department of Health and Children Seminar April 2005 Lot 3 Fissure Sealing and the Targeted Approach to Service Delivery Oral Health Services Research Centre

2 User Group Members Dr Mary OrmsbyChair Dr Riana ClarkeJoint secretary Dr Michael MulcahyJoint secretary Dr Padraig Creedon Dr Nader Farvardin Dr Gerard GavinDOH&C Dr Joe Green Dr Margie Houlihan Dr John Jones Dr Dympna Kavanagh Dr Maria Kenny Dr Stephen Mc Dermott Dr Mary OConnor Dr Mary O Farrell Dr Dan O Meara Dr Colleen O Neill Dr Carmel Parnell Dr Matt Walshe

3 Project Team - OHSRC Professor Denis OMullane - PI Dr Helen Whelton – Deputy PI Dr Rose Kingston Dr Evelyn Crowley Dr Paul Beirne Ms Jennifer Leyden Ms Elspeth Cameron

4 Format of Presentation: Background to Lot 3 Targeting of Health Board Dental Services Fissure Sealants Development of strategy for needs assessment within HBDS Policy Issues relating to guidance on fissure sealants in HBDS Further Research

5 Background to Lot 3

6 Two Strategies Two distinct approaches to the control of illness (Rose 1985): Population approach – aims to control the occurrence of new disease in a population High risk approach – identifies individuals at high risk of disease and targets them for treatment and/or prevention

7 Reason for Targeting Services Early identification of those at high risk of disease; target for prevention and/or treatment Economics – rationing of services These two issues provide rationale for current targeted approach to service delivery in HBDS

8 Fissure Sealants A fissure sealant is a substance that is placed in the pits and fissures of teeth in order to prevent the development of caries

9 Public Dental Service Reviews

10 The Leyden Report (1988) The adoption of a national strategy for the delivery of dental services to ensure an equal standard of service for all persons Recommended that specific classes in national schools be targeted for treatment & prevention and additional dental teams recruited to meet the needs of the childrens dental service 1 st /2 nd, 4 th and 6 th classes

11 National Survey Childrens Oral Health Decline in prevalence of dental caries 60% of total caries experience in perm teeth of 8-year-olds contributed by 1 st perm molars Occlusal surfaces only involved in 50% of 1 st perm molars affected by caries (Holland et al 1986)

12 Recommendation NSCOH 1984 Increased use of fissure sealants in combination with fluoride will lead to substantial further reductions in dental caries Studies be undertaken to investigate cost- effectiveness in order to inform policy on the use of fissure sealants in HBDS

13 Dental Health Action Plan (1994) The health boards dental services were moving from a demand led service towards a targeted service with increasing emphasis on the treatment of special needs patients Dental Health Education and prevention given priority

14 Lot 3

15 Aims: To assess the current situation of targeting of general dental services in the Health Board To assess the current patterns of use of fissure sealants in the HBDS and their future use

16 Lot 3 - Methods Situation analysis Information gathering (Literature Review) Review of existing services Secondary data analysis Consultation process Findings and Recommendations Information Dissemination

17 Lot 3 Related Projects National Survey Childrens Dental Health (Whelton et al 2002) An Evaluation of a fissure sealant programme in Co.Meath, Ireland (Parnell et al 2003)

18 Lot 3 Related Projects MDPH Projects: An audit of fissure sealing in the Eastern Health Board (Clarke 1999) An assessment of the use of the targeted approach in the HBDS (Mulcahy 2001) An economic evaluation of the use of dental hygienists in the fissure sealant programmes of the public dental service of the MidWestern Health Board Public Dental Services (O Connor 2002)

19 Lot 3 Caries Risk

20 % of total caries experience contributed by top 20% of dmft/DMFT score

21 Caries Risk Assessment Difficult to predict despite many national and international studies Whelton (1989) and Kavanagh (1994) Two reasonably sensitive criteria: - Subjects with previous caries experience - Clinicians clinical opinion

22 Lot 3 Targeting

23 Targeting of Health Board Dental Services Wide variation between boards in the adoption of the targeted approach (Mulcahy 2001) Targeting particular classes unlikely to select appropriate at risk groups for treatment and preventive services

24 Targeting of school classes for fissure sealing

25

26 Conclusion The unexpected wide variation in timing of eruption of 1 st and 2 nd permanent molars makes targeting of particular school classes for fissure sealing programmes problematic

27 Recommendations Need to re-direct and re-orientate services to being needs based Adoption of national needs assessment strategy which would include a national school dental screening programme

28 Major Findings Lot 3 Fissure Sealants

29 1) There is a wide variation in the extent to which different boards have put in place fissure sealant programmes Level and pattern of use of fissure sealing varies widely within and between health boards No agreed policy on the use of fissure sealants in the HBDS - Classes targeted - Skill mix - Blanket seal/ Targeted approach

30 % of 8-year-old children with at least one fissure sealant on their permanent teeth by disadvantage status

31 % of 12-year-old children with at least one fissure sealant on their permanent teeth by disadvantage status

32 % of 15-year-old children with at least one fissure sealant on their permanent teeth by disadvantage status

33 National Survey Children's Oral Health ) A very high proportion of dental decay occurs in pits and fissures

34 3) Fissure sealants are effective at preventing pit and fissure caries Sealing with resin based sealants is a recommended procedure to prevent caries of the occlusal surfaces of permanent molars – Cochrane Systematic Review 2004 Sealants are highly effective in preventing dental caries in pits and fissures of teeth when applied by trained operators in clinical trials and community health programmes – BSPD 2000 After 4.5 years sealed permanent molar teeth of children 5-10 years had reduction of decay in over 50% of biting surfaces compared to teeth without sealants - Cochrane Systematic Review 2004

35 4) Pits and fissures remain at risk of caries for long periods of time Slowing of the rate of progression Change in caries risk status All vunerable pits and fissures should be considered for fissure sealing irrespective of the length of time they have been in the mouth – Locker (2003)

36 5) Fissure sealants can be applied in at-risk, caries free teeth and as therapy for incipient lesions 6) Fissure sealants are best used as part of an overall preventive programme

37 7) Fluoride has limited effect in preventing pit and fissure caries 8) Application of fissure sealants should be based on individuals, tooth and surface risk

38 9) The key to sealant success is sealant retention Gillcrist et al The effectiveness of a dental sealant depends upon its long term clinical retention and regular maintenance sealant retention sealant success As long as a fissure sealant remains intact, that surface will be protected from initiation of dental caries or progression of existing incipient caries

39 10) Regular assessment of fissure sealants necessary to monitor retention Most sealant failures occur within 6-12 months of placement (1995 workshop) Sealants should be regularly reviewed and repaired or replaced as necessary to ensure continued success

40 Development of a Strategy for Needs Assessment and use of Fissure Sealants within the HBDS

41 The following issues need to be taken into consideration in development of future strategy: Children with extensive decay in their primary teeth should have all 1 st permanent molars sealed as soon as possible after eruption Children may need to be examined using agreed criteria, when they are in senior infants, 1 st and 2 nd class to determine risk status of the 1 st permanent molar

42 Any child in any class with dmft/DMFT > 1 necessitates full examination and treatment including fissure sealing all sound molars All children with special needs or who are disadvantaged should be prioritised for oral health care

43 Any child with dmft/DMFT > 1 should be screened in 6 th class, 1 st and 2 nd year to ensure sealing of second permanent molars All teeth which are fissure sealed should be reviewed within one year of placement and thereafter at regular recall visits

44 Appropriate recall intervals will take into consideration the recent NICE Clinical Guideline on Dental Recall (Oct 2004) Any screening of any child at any age implies all treatment needs should be identified and treatment provided, within a reasonable period of time

45 Policy Issues relating to guidance on Fissure Sealants in HBDS

46 Annual screening/examination/recall of most children from senior infants to 2 nd /3 rd of secondary school year to identify children and teeth at risk Specific training criteria for dental personnel in identification of at risk individuals Specific training criteria for dental personnel in application and maintenance of fissure sealants

47 Need for a robust IT system to monitor sealant placement and effectiveness Recall interval for children under 18 years < 12 months (NICE Guidelines) Need for appropriate skill mix within HBDS

48 Other Topics under Lot 3

49 Other Lot 3 Topics The management of traumatic injuries to incisors The management of caries in primary teeth

50 Trauma The percentage of children and adolescents with trauma to one or more of their front teeth has not improved since 1984 All HB

51 Trauma The percentage of children and adolescents affected by trauma who have at least one traumatised permanent incisor untreated has not improved since 1984

52 Caries in primary teeth Wide variation between health boards in the percentage of untreated total decay experience in primary teeth

53 Caries in primary teeth Need for longitudinal studies to monitor the consequences of a treatment vs non- treatment approach of primary teeth on the general health and oral health of children

54 Further Research

55 Required in area of fissure sealants and targeting of health board dental services Recommended further research: eg. –Eruption times 1 st and 2 nd permanent molars –Present fissure sealant retention rates in HSE areas –Pilot study of proposed national screening programme –Causes of traumatised primary and permanent incisors

56 Acknowledgement The contribution of the User Group to the successful completion of the Lot 3 project is acknowledged


Download ppt "Department of Health and Children Seminar April 2005 Lot 3 Fissure Sealing and the Targeted Approach to Service Delivery Oral Health Services Research."

Similar presentations


Ads by Google