BackgroundBedtime routines has shown important associations with areas associated with child wellbeing and development. Research into bedtime routines is limited with studies mainly focusing on quality of sleep. The objectives of the present study were to examine the relationship between bedtime routines and a variety of factors associated with child wellbeing and to examine possible determinants of bedtime routines.MethodsA total of 50 families with children between 3 and 5 years old took part in the study. Data on bedtime routines, parenting styles, school readiness, children’s dental health, and executive function were collected.ResultsChildren in families with optimal bedtime routines showed better performance in terms of executive function, specifically working memory (t (44)= − 8.51, p ≤ .001), inhibition and attention (t (48)= − 9.70, p ≤ .001) and cognitive flexibility (t (48)= − 13.1, p ≤ .001). Also, children in households with optimal bedtime routines scored higher in their readiness for school (t (48)= 6.92, p ≤ .001) and had better dental health (U = 85.5, p = .011). Parents in households with suboptimal bedtime routines showed worse performance on all measures of executive function including working memory (t (48)= − 10.47, p ≤ .001), inhibition-attention (t (48)= − 10.50, p ≤ .001) and cognitive flexibility (t (48)= − 13.6, p ≤ .001). Finally, parents with optimal bedtime routines for their children deployed a more positive parenting style in general (i.e. authoritative parenting) compared to those with suboptimal bedtime routines (t (48)= − 6.45, p ≤ .001).ConclusionThe results of the present study highlight the potentially important role of bedtime routines in a variety of areas associated with child wellbeing and the need for further research.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5290-3) contains supplementary material, which is available to authorized users.

BackgroundUntreated caries in young children can result in a referral for extraction in hospital under general anaesthetic (GA). This study aims to explore the impact of caries during the ensuing wait for GA on children resident in the North West of England.MethodsThe study involved 456 respondents referred to six hospitals in the Northwest of England. Over a two-month period each of these children/ families completed a questionnaire and gave permission to access their referral and consultation notes.ResultsChildren (6.78 years old: 1.50 to 16.42) had on average five teeth extracted (ranging from one to a full clearance, with all teeth removed). Sixty seven per cent of parents reported their child had been in pain, 26% reported schools days being missed and 38% having sleepless nights. The average time from referral to operation was 137 days. Results indicated that children could be in discomfort during their wait, as pain was experienced, on average, 14 days before the operation. Wait time significantly predicated the number of sleepless nights b = .004, t(340) = 2.276, p = .023.ConclusionsIt is clear that pain, sleepless nights and missed school are a feature during a wait for dental GA and can be exacerbated by an extended wait. These data support the need for not only effective prevention of caries within primary care to reduce wait times and experience of GA but also effective management of pain and infection during a prolonged wait for treatment.

BackgroundTo determine the association between social deprivation and the prevalence of caries (including caries lesions restricted to enamel) and enamel fluorosis in areas that are served by either fluoridated or non-fluoridated drinking water using clinical scoring, remote blinded, photographic scoring for caries and fluorosis. The study also aimed to explore the use of remote, blinded methodologies to minimize the effect of examiner bias.MethodsSubjects were male and female lifetime residents aged 11–13 years. Clinical assessments of caries and fluorosis were performed on permanent teeth using ICDAS and blind scoring of standardized photographs of maxillary central incisors using TF Index (with cases for fluorosis defined as TF > 0).ResultsData from 1783 subjects were available (910 Newcastle, 873 Manchester). Levels of material deprivation (Index of Multiple Deprivation) were comparable for both populations (Newcastle mean 35.22, range 2.77-78.85; Manchester mean 37.04, range 1.84-84.02). Subjects in the fluoridated population had significantly less caries experience than the non-fluoridated population when assessed by clinical scores or photographic scores across all quintiles of deprivation for white spot lesions: Newcastle mean DMFT 2.94 (clinical); 2.51 (photo), Manchester mean DMFT 4.48 (clinical); 3.44 (photo) and caries into dentine (Newcastle Mean DMFT 0.65 (clinical); 0.58 (photo), Manchester mean DMFT 1.07 (clinical); 0.98 (photo). The only exception being for the least deprived quintile for caries into dentine where there were no significant differences between the cities: Newcastle mean DMFT 0.38 (clinical); 0.36 (photo), Manchester mean DMFT 0.45 (clinical); 0.39 (photo). The odds ratio for white spot caries experience (or worse) in Manchester was 1.9 relative to Newcastle. The odds ratio for caries into dentine in Manchester was 1.8 relative to Newcastle. The odds ratio for developing fluorosis in Newcastle was 3.3 relative to Manchester.ConclusionsWater fluoridation appears to reduce the social class gradient between deprivation and caries experience when considering caries into dentine. However, this was associated with an increased risk of developing mild fluorosis. The use of intra-oral cameras and remote scoring of photographs for caries demonstrated good potential for blinded scoring.

BackgroundExtensive caries in children can result in a referral for tooth extraction under General Anaesthesia (GA). While there are guidelines for the use of GA within paediatric dentistry this process is ultimately dependent upon the decision making of the treating dentist. This decision can be influenced locally by the availability of services and their waiting list. GA services for paediatric extractions (DGA) have developed from different historical positions, including community dental services, maxillofacial services and paediatric led specialist services.MethodsThis article explores the differences between DGA services provided by 6 randomly selected hospitals across the North West of England. 456 patients who attended a routine DGA appointment in each hospital over a period of two months from 2012 to 2013 gave consent to allow access to their clinical notes and completed a questionnaire (93% consent rate). Data were entered onto SPSS and appropriate statistical tests undertaken.ResultsDifferences between hospitals included the clinic structure, patient characteristics and the treatment provided. There was a significant difference in the number of previous child DGAs experienced within the family, ranging from 33% to 59% across hospitals. Hospital 1 attendees differed in a number of ways to other areas but notably in the stability of life time residency with 20% of patients having previously lived in another area and with just 58% of parents stating their child regularly attended the dentist (compared to an average of 9% and 81% respectively across other hospitals).ConclusionFindings suggest services throughout the region face different obstacles in providing support and treatment for young children referred for DGA. There are, however common practices such as preventative treatment, which could impact on caries experience and subsequent DGA referral, a particular issue given the high DGA repeat rate observed. For many children a DGA may be their first dental experience. It is therefore vital to engage with both child and family at this stage, attempt to initiate a pattern of dental attendance and to ensure this experience does not create an on-going cycle of poor dental behaviour and health.Electronic supplementary materialThe online version of this article (doi:10.1186/s12903-015-0028-4) contains supplementary material, which is available to authorized users.

BackgroundPatterns of service delivery and the organisation of Dental General Anaesthesia (DGA) have been found to differ across hospitals. This paper reports on qualitative research aimed to understand the impact of such variation by exploring views and experiences of families receiving care in different hospital sites, as well as dentists involved in referral and delivery of care.MethodQualitative semi-structured interviews were conducted with 26 people comprising parents (n = 15), dentists working in primary care (n = 6) and operating dentists (n = 5) in relation to DGA. Participants were recruited from areas across the North West of England to ensure a variety referral and treatment experiences were captured. Field notes were made during visits to all settings included in the study and explored alongside interview transcripts to elicit key themes.ResultsA variety of positive and negative impacts on children and parents throughout the referral process and operation day were apparent. Key themes established were clustered around three key topics:Organisational and professional concerns regarding referrals, delivery of treatment and prevention.The role of hospital environment and routine on the emotional experiences of children.The influence of the wider social context on dental health.ConclusionThese findings suggest the need and perceived value of: tailored services for children (such as play specialists) and improved information, such as clear guidance regarding wait times and what is to be expected on the day of the procedure. These features were viewed to be helpful in alleviating the stress and anxiety often associated with DGA. While some elements will always be restricted in part to the hospital setting in which they occur, there are several aspects where best practice could be shared amongst hospitals and, where issues such as wait times have been acknowledged, alternative pathways can be explored in order to address areas which can impact negatively on children.Electronic supplementary materialThe online version of this article (doi:10.1186/s12903-015-0029-3) contains supplementary material, which is available to authorized users.

BackgroundTo determine if a novel dual camera imaging system employing both polarized white light (PWL) and quantitative light induced fluorescence imaging (QLF) is appropriate for measuring enamel fluorosis in an epidemiological setting. The use of remote and objective scoring systems is of importance in fluorosis assessments due to the potential risk of examiner bias using clinical methods.MethodsSubjects were recruited from a panel previously characterized for fluorosis and caries to ensure a range of fluorosis presentation. A total of 164 children, aged 11 years (±1.3) participated following consent. Each child was examined using the novel imaging system, a traditional digital SLR camera, and clinically using the Dean’s and Thylstrup and Fejerskov (TF) Indices on the upper central and lateral incisors. Polarized white light and SLR images were scored for both Dean’s and TF indices by raters and fluorescence images were automatically scored using software.ResultsData from 164 children were available with a good distribution of fluorosis severity. The automated software analysis of QLF images demonstrated significant correlations with the clinical examinations for both Dean’s and TF index. Agreement (measured by weighted Kappa’s) between examiners scoring clinically, from polarized photographs and from SLR images ranged from 0.56 to 0.92.ConclusionsThe study suggests that the use of a digital imaging system to capture images for either automated software analysis, or remote assessment by raters is suitable for epidemiological work. The use of recorded images enables study archiving, assessment by multiple examiners, remote assessment and objectivity due to the blinding of subject status.

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