 Define evidence based medicine.  Identify the grades of the hierarchy of evidence.  Identify some of the topics included in the toolkit for prevention.  Identify advice that should be given to prevent caries in under 3 year olds.  Identify advice that should be given to prevent caries from aged 7 and young adults.  Identify key points of good dietary advice.  Identify risk factors of periodontal disease.  Identify sources of acid that may lead to tooth wear.  Pass an assessment, scoring over 70%.

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Delivering better oral health: an evidence-based toolkit for prevention

This review focuses on the clinical interactions between patients and the dental team, not on caries prevention at a public health level. Many dentists no longer take a narrow surgical view seeking to apply interventive treatment as a one-off event at a certain trigger point of disease severity and the evidence that caries is an initially reversible, chronic disease with a known multi-factorial aetiology is being appreciated more widely. The caries process should be managed over time in an individualized way for each patient. Very few individuals can be considered to be truly 'caries free' when initial lesions as well as more advanced dentine lesions are considered. It is now very clear that, by itself, restorative treatment of the disease does not 'cure' caries. The caries process needs to be managed, in partnership with patients, over the changing challenges of a lifetime. The answer to the question posed in the title should be, in many cases, that we are ready to move to non-operative/preventive care (if we have not done so already). However, this should be for appropriate stages of lesion extent and in patients who respond to advice on recall frequency and preventive behaviours.

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Are we ready to move from operative to non-operative/preventive treatment of dental caries in clinical practice?

As a profession we have a responsibility to ensure that the oral health needs of individuals and groups who have a physical, sensory, intellectual, medical, emotional or social impairment or disability are met. In the UK, over 200,000 adults have profound learning disabilities and/or complex medical conditions. Adults with a disability often have poorer oral health, poorer health outcomes and poorer access to services than the rest of the population. This paper examines the need for Special Care Dentistry based on a review of published literature, surveys and health policy, and suggests how services might be delivered in the future. Existing models of good practice reveal that established clinicians working in this fi eld have a patient base of between 850 and 1,500 patients per year and work across primary care and hospital settings, liaising with colleagues in health, social services and the voluntary sector to ensure integrated health care planning. On this basis, a conservative estimate of 133 specialists is suggested for the future, working in networks with Dentists with Special Interests (DwSIs) and primary dental care practitioners. A skilled workforce that can address the wider needs of people requiring Special Care Dentistry should be formally recognised and developed within the UK to ensure that the needs of the most vulnerable sections of the community are addressed in future.

Special care dentistry: a professional challenge

CHILDREN'S SURVEY Background The 2003 Children's Dental Health Survey is the fourth in a series of decennial national children's dental health surveys. Aims This paper reports the survey-derived estimates of dentinal caries experience of children aged five, eight, 12 and 15 years, considering the trends over recent decades and the position in 2003 following changes in disease presentation and the use of additional criteria. Methodology A representative UK sample of children in the four specified age groups were invited to participate in a clinical dental examination in school. A total of 12,698 children were sampled and 10,381 were examined (82%). Examinations were undertaken in school by trained and calibrated examining teams using reclining chairs and portable lights, the criteria were visual, limited to dentine caries and no diagnostic aids were employed. In order to compare trend data with 1993 and earlier surveys the criteria allowed the re-classification of the full 2003a results (those including cavities and visual dentine caries - D3cvMFT/d3cvmft) according to the previous criteria to produce results labelled 2003b (those restricted to dentinal cavities - D3cMFT/d3cmft). Results and conclusions The experience of obvious dentinal caries in children within the UK has continued to change over the last decade and patterns are different for the two dentitions. While continuing overall improvements are evident for permanent teeth across the UK (D3c for 15-year-old children falling from 42% in 1983, via 30% in 1993 to 13% in 2003 for example), trends amongst those experiencing dentinal caries are more concerning and there have been no statistically significant improvements for primary teeth (the mean number of teeth with obvious dentine decay (d3c) at age five years being 1.3 in 1983 and 1.4 in both 1993 and 2003). The inclusion in the criteria of visual dentinal caries resulted in higher estimates of mean caries and mean caries experience in the permanent dentition (at age 15 years D3 increasing from 0.2 to 0.8, D3MFT increasing from 1.6 to 2.0 for example) but not the primary dentition (where the estimates for % d3mft at age five years were identical at 43%). Geographic variations also persist across the UK (% with D3cvMFT at 12 years being 41% for England, 54% Wales, 73% Northern Ireland and 43% for the UK; % with d3cvmft at age 5 years: 41% for England, 52% Wales, 61% Northern Ireland and 43% for the UK). These survey results have implications for planning and for daily practice, but must be interpreted carefully acknowledging the specific survey conditions and diagnostic criteria employed.

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The dentinal caries experience of children in the United Kingdom, 2003.

Contributing co-authors* Christopher Deery, University of Sheffield, UK Roger Ellwood, University of Manchester, UK Juliana Gomez, University of Manchester, UK Justine Kolker, University of Iowa, USA David Manton, University of Melbourne, Australia Michael McGrady, University of Manchester, UK Peter Rechmann, University of California San Francisco, USA David Ricketts, University of Dundee, UK Van Thompson, Kings College, London, UK Svante Twetman, University of Copenhagen, Denmark Robert Weyant, University of Pittsburgh, USA Andrea Ferreira Zandona, University of North Carolina, USA Domenick Zero, Indiana University School of Dentistry, USA

https://www.icdas.org/uploads/ICCMS-Guide_Full_Guide_UK.pdf

ICCMS™ Guide for Practitioners and Educators

Acknowledgements v Stakeholder Organisations vii Abbreviations used in Guideline ix 1 Introduction 1 1.1 Background 1 1.2 What is a guideline? 2 1.3 Remit of the Guideline 3 1.4 What the guideline covers 3 1.5 What the guideline does not cover 3 1.6 Who developed the guideline? 3 1.7 Guideline Methodology 4 1.7.1 Outline of methods used 4 1.7.2 Questions addressed in developing the guideline 4 1.7.3 Systematic Review Methods for Key Clinical Questions 5 1.7.4 Hierarchy of evidence 6 1.7.5 Health economics methods 6 1.7.6 Forming and grading the recommendations 7 2 Clinical effectiveness and cost-effectiveness of routine dental checks (HTA update) 9 2.1 Characteristics of the Included Studies 9 2.1.1 Characteristics of the study settings and study design 9 2.1.2 The accuracy of clinical oral examinations in detecting oral cancer and potentially malignant conditions 31 3.3.5 Toluidine blue dye 31 3.3.6 Potentially malignant lesions and conditions 31 3.4

A Williams

Papers

Dental Recall. Recall Interval between Routine Dental Examinations