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Below is how the Humberside cluster have interpretted the extra box ticking exercise which was included in the 2011/2012 Pay Award

Implementing Delivering Better Oral Health (DBOH)

The view of the Humber Cluster Dental Development Group

  1. Background

DBOH (2nd edition) provides detailed evidence based guidance on preventing dental and oral disease related to age and relative risk. Summary guidance lists those interventions that are appropriate and effective for children, adults and vulnerable groups dependent on assessed risk of disease.

A brief summary of the basic requirements of DBOH is given below.

  1. Children

    • Fluoride Varnish for all children aged 3 – 16 twice yearly. * see below
  • Advice to parents and children on diet, daily brushing with fluoride     toothpaste ** and sugar free medicines
  • Higher risk children may also require a fluoride mouth rinse or higher dose fluoride toothpaste and fissure sealants.

  1. Adults

  • Advice on daily brushing with fluoride toothpaste  
  • Advice on limiting sugar in the diet and eating 5 portions of fruit and vegetables per day 
  • BPE , smoking status and alcohol intake as part of oral assessment
  • Referral to Stop Smoking / Alcohol advice services if appropriate
  • Prescribing high dose fluoride toothpaste for high risk patients

Notes:

  1. * The rationale for a whole population approach to Fluoride Varnish is that we cannot accurately predict who is likely to develop dental caries in an otherwise healthy mouth so the programme cannot be targeted. It is only when there is a history of caries that any meaningful assessment can be made. Clinical evidence from the Cochrane Systematic Review supports a whole population approach.

  1. ** Recommended fluoride levels in toothpaste do vary locally dependent on the group being considered.

  • Community programmes aimed at families or other groups who do not seek regular care use 1350/1450 ppm because of the one- off nature of the programmes and the higher risk of dental disease.

  • Tailored programme eg in dental practices using  DBOH guidelines – 1000ppm under 3 and 1350/1450 ppm age 3 and over.

  • Long term community programmes such as the Hull and East Yorkshire “Brush Bus” programmes use 1000ppm up to age 6 ( Key stage 1) and 1350 ppm for age 7 upwards ( Key Stage 2) (see below)

Comment : We have had a long debate in Hull over toothpaste F’ levels for our brush bus schools programme and concluded that we use 1000 ppm up to age 6 and 1450 ppm after that. We took advice from the Childsmile, the Scottish Oral Health programme and Chris Deery, the Prof of Paedodontics at Sheffield. However it is different from an individual programme in a dental practice where the caries risk and likelihood of fluorosis  is potentially easier to assess.  In community programmes for high risk under 6’s where compliance is erratic and family income  precludes multiple types of toothpaste, then 1350/1450 ppm is preferable.  

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