INTRODUCTION AND AIMS:The high prevalence of dental caries is recognised as a public health challenge in Saudi Arabia. The shift from treatment-based approaches to prevention is one of the objectives to control caries prevalence. Two evidence-based methods to prevent caries are applying fluoride varnish (FV) and fissure sealants (FS). However, data on practices related to their application is limited. Therefore, this study aims to: (1) assess the extent to which General Dental Practitioners (GDPs) in primary healthcare centres in Saudi Arabia provide FV and FS for children aged 14 years and younger; and (2) identify overall preventive measures they deliver in practice. METHODS:A multicentre, prospective, descriptive cross-sectional study was conducted in Jazan province, Saudi Arabia, April to August 2024. Direct clinical observation allowed quantification of GDPs' application of FV and FS in routine clinical care for children aged 14 years and younger. This was compared against current evidence-based practice guidelines. RESULTS:Thirty-five GDPs were observed treating 643 children. Although 98% of children met eligibility criteria to receive FV, only 4% received it. Similarly, 74% were eligible for FS, and only 2% received one or more sealants. Caries prevention advice was provided in 80% of consultations, and the most frequently delivered preventive measure was toothbrushing instruction. CONCLUSION:Despite high levels of eligibility according to recommendations, there were low delivery rates of FV and FS by GDPs, for children in primary healthcare centres in Saudi Arabia, highlighting the gap between evidence-based guidelines and clinical practice. CLINICAL RELEVANCE:The finding of this study indicates that the adoption of international guideline recommendations on the use of FV and FS in Saudi Arabia has been insufficient to optimise the delivery of these preventive interventions. This highlights the need for further research to understand the behaviour determinants that influence GDPs in delivering them. Review retrospectively registered: Open Science Framework https://doi.org/10.17605/OSF.IO/2XS6G.

OBJECTIVES:Caries prevalence remains high in Latvia, with limited adoption of minimally invasive dentistry (MID). While provider barriers are known, parental perspectives are underexplored. This study examined Latvian parents' views on MID to identify key barriers and facilitators to its acceptance. METHODS:An inductive qualitative approach was applied to explore parents' perceptions of non-invasive and minimally invasive caries management strategies. Data were collected using semi-structured interviews, conducted with parents (n = 19) whose children had experience of either minimally invasive or traditional caries management. All interviews were recorded, transcribed verbatim and analysed with reflexive thematic analysis. RESULTS:Four main themes were generated: (1) 'avoiding unnecesary discomfort and distress' described parents' views and experiences of non-invasive and minimally invasive caries management strategies as physically and psychologically less traumatic for their child and themselves; (2) 'prioritising treatment qualities', explored parents' expectations and priorities regarding the qualities offered by different dental treatment options; (3) 'the power of information', illustrated that parents' awareness of non-invasive and minimally invasive caries management strategies contributed to a better understanding of treatments and promoted choice, but required access to that information; and (4) 'choices of suitable options', described parents' reflections on having a variety of options for dental treatment, rather than a single option offered. CONCLUSIONS:Parents value effective communication, clear information and access to treatment options when considering minimally invasive caries management. Their views highlight the need for a shift towards patient-centred care models that prioritise comfort, informed decision-making and choice in paediatric dentistry.

BACKGROUND:Children with limited access to dental care can be negatively impacted by reduced frequency of oral health monitoring, delays in diagnosis of dental disease and increased waits for dental care, resulting in them experiencing more disease (extent and amount). Smartphone-based intraoral photography has been cited as having the potential to improve oral health monitoring for children through screening; however, it has not been well evaluated, and its limitations are unclear. The picture-perfect study aims to assess diagnostic accuracy, feasibility and acceptability to determine whether remote photographic monitoring can be effectively integrated into pathways of dental care for children aged 6-16 years. METHODS:Observational, cross-sectional, mixed-methods study with three workflows: Workflow 1: development of user-friendly, comprehensive guidance to help parent/carers (parents) take high-quality intraoral photographs of their children's mouths. The guidance will be codesigned with parents and healthcare professionals. Workflow 2: diagnostic accuracy using intraoral photographs taken by a parent of their children will be evaluated by comparing clinicians' diagnoses from the photographs to gold-standard clinical visual-tactile examinations. Parent-child dyads (n=110) will be recruited to capture intraoral photographs using positioning aids, guidance and smartphones provided by the research team. The diagnoses will focus on plaque accumulation, gingival health, restoration status and dental caries. Diagnostic accuracy will be assessed using sensitivity, specificity, positive predictive value, negative predictive value and area under the curve. Workflow 3: assessment of feasibility and acceptability will be through task completion rates, photograph quality and participant feedback. Qualitative interviews and an online survey will capture parents' and children's experiences. Observational data will provide insights into practical challenges. ETHICS AND DISSEMINATION:This study, approved by the National Health Service (NHS) Research Ethics Committee (Integrated Research Application System [IRAS]: 24/EE0137), will be conducted in adherence to the Declaration of Helsinki and Good Clinical Practice (GCP) guidelines. Written informed consent will be obtained from all participating parents, with age-appropriate assent from children prior to enrolment. Participants have the right to withdraw at any time without explanation, and their data will be anonymised to ensure privacy and confidentiality. Study findings will be disseminated through peer-reviewed journals, conference presentations and reports to relevant stakeholders. TRIAL REGISTRATION:The study protocol has been registered on the Open Science Framework: https://doi.org/10.17605/OSF.IO/WX29D.

Introduction Artificial intelligence (AI)-powered mobile applications (apps) like TestMyTeeth offer potential for at-home dental plaque screening.Objective To evaluate usability and user perceptions of the TestMyTeeth app for remote plaque detection.Methods A cross-sectional study with adult participants recruited using convenience sampling. Participants used the app and completed an online questionnaire including the system usability scale (SUS) and user experience items. Descriptive statistics summarised demographics and responses. SUS scores and non-parametric tests assessed usability differences across age, education level and sex.Results For 132 participants recruited (75% female; 90% under 44 years-old), the mean SUS score was 56.2 (standard deviation ± 13.5; range: 10-85), indicating 'marginal' acceptability. Additionally, 54.6% were interested in frequent use, 41.6% found the app easy to use and 50% needed technical support. Participants found significant challenges capturing intra-oral photographs, especially for posterior teeth. No significant SUS score differences were found for age (p = 0.951), education level (p = 0.569), or sex (p = 0.154). Qualitative feedback highlighted benefits of self-monitoring but concerns about app complexity and accuracy without professional guidance.Conclusion The app shows potential for empowering at-home dental plaque screening but faces usability challenges. Improvements in user interface and photo-capture functionality would enhance usability.

Over the past quarter-century, pediatric dentistry has shifted from an expert-opinion-driven craft-often extrapolated from adult dental care, to become a discipline anchored in rigorous, child-specific evidence. This transformation reflects the maturation of evidence-based dentistry (EBD): integrating the best available research with clinical expertise and the values and preferences of children and their families. As we celebrate the Journal of Evidence-Based Dental Practice at 25years of age, this article charts some milestones in pediatric EBD that show how clinical practice has led to scientific enquiry, research investigations and widespread changes in practice. The examples used are the Hall Technique, Atraumatic Restorative Treatment and pulp canal obliteration in dental trauma management. A pathway to improve research impact is proposed, stretching from ensuring research relevance and methodological rigor through to talking and listening to those who are stakeholders, planning implementation of findings, using core- and patient relevant- outcome sets, public communication and open science. Change does not have to be global to be important: locally tailored, context-aware research and its implementation can improve children’s oral healthcare, reduce inequalities and deliver value. This article is part of the special issue "Celebrating 25 Years of the Journal of Evidence-Based Dental Practice".

BACKGROUND:Untreated dental caries is the most common condition to affect children globally, and significantly affects their oral health-related quality of life. Our understanding of caries and its management has progressed significantly over the past two decades, though a number of Dental Schools in the United Kingdom (UK) continue to teach traditional techniques, which no longer align with the evidence base. There is a clear need for an evidence-based curriculum for paediatric caries management for UK Dental Schools. This protocol details a study to generate consensus on what should be included in such a curriculum. METHODS:Preliminary research by the authors will be used to identify techniques to be considered for inclusion in the curriculum and their definitions will be drawn from scientific literature. A total of 21 national and international experts in paediatric cariology will be invited to take part in a Delphi survey, via the Welphi application. Participants will be given a list of techniques, with associated definitions, and asked to state whether each should be included in the curriculum, or not, or if they are unsure. Techniques with at least 70% agreement will be removed from future survey rounds. Participants will be provided with feedback regarding all techniques not reaching a consensus, and asked to re-evaluate these again, up to a maximum of four rounds. Seven UK-based Delphi participants will then be invited to participate in a Nominal Group Technique approach, to confirm suitability of the techniques agreed for inclusion in a UK curriculum, reviewing and discussing where agreement was previously not reached. The final list of approved techniques will inform a UK paediatric caries management curriculum, which will be developed with involvement of stakeholders. Endorsement for this curriculum will be sought from the British Society of Paediatric Dentistry. The UK General Dental Council will be asked to consider its content as part of the standards for UK Dental Schools. Following dissemination of the curriculum we will seek to investigate whether there is greater alignment across UK Dental Schools with the evidence base for cariology. CONCLUSION:This study proposes a rigorous approach to curriculum development with active involvement of a broad range of stakeholders. These methods can be applied to development of further curricula in dental education, benefitting the teaching community, students and patients.

Introduction: Despite evidence supporting the clinical and cost-effectiveness of minimally invasive dentistry (MID), its adoption by the dental profession has been slow. A systematic review in 2016 found the majority of dentists intervene invasively earlier than necessary. The aim was to update this review of the assessment of dental practitioners' thresholds for providing restorative treatment for carious lesions given changes in evidence, teaching, and guidelines since 2016. The primary outcome was dental practitioners' restorative thresholds (the extent of the lesion when they would decide to intervene restoratively). Secondary outcomes were changes over time, caries risk, regional differences, and primary/permanent dentition. METHODS:This updated review replicated the methodology for the initial review, following the PRISMA 2020 guidelines (PROSPERO; CRD42023431906). Embase, MEDLINE (via PubMed), and Web of Science databases were searched (2016-2023) for observational studies reporting on dental clinicians' thresholds for restorative interventions in adults and children without language, time, or quality restrictions. Screening, data extraction, and risk of bias assessment (Modified Newcastle-Ottawa Scale) were carried out independently and in duplicate. Meta-analyses were performed using a random-effects model. No funding sought. RESULTS:Overall, 47 publications (30 from original publication and 17 from updated search) met the inclusion criteria and 65 datasets were included in the meta-analyses: 19 for occlusal lesions (16 pre-2016 and 3 post-2016; n = 11,946) and 46 for proximal lesions (38 pre-2016 and 8 post 2016; n = 20,428). The meta-analyses found that for occlusal lesions confined to enamel, there were fewer practitioners intervening invasively: 5% (95% confidence interval [CI]; 1-20%) post-2016, compared with 15% (95% CI; 9-23%) pre-2016. The opposite was found for proximal lesions with increased intervention levels, 27% (95% CI; 18-40%) for lesions confined to enamel post-2016, compared with 19% (95% CI; 12-29%) pre-2016, and for lesions extending up to the enamel-dentine junction 61% (95% CI; 36-81%) post-2016, compared with 39% (95% CI; 29-51%) pre-2016. There was variance between regions but too few studies to draw conclusions on individual regions. CONCLUSION:There was a suggestion of less invasive treatment of occlusal lesions over time; however, this was not evident for proximal lesions. .

Dental caries impacts children’s health- and oral health-related quality of life. Preference-based measures (PBM) can quantify these impacts as utilities, facilitating economic evaluation of interventions. Two paediatric PBMs (one generic (CHU9D) and one condition-specific (CARIES-QC-U)) were used in the BRIGHT randomised control trial investigating the impact of a behaviour change intervention on schoolchildren’s oral health. No comparison has been made of these two instruments previously. This study aimed to compare the psychometric properties of CHU9D and CARIES-QC-U using trial data. Baseline trial data were assessed. Mean utility scores, missing values and floor and ceiling effects were determined for each instrument. Cronbach’s alpha was assessed to indicate internal consistency for each instrument. Correlations were explored between CARIES-QC-U and CHU9D, the dimensions within the two instruments, and between each instrument and DMFT. Effect sizes (Cohen’s d) were explored for each component of DMFT in relation to overall utility values from each instrument. Baseline data from 4542 schoolchildren aged 11–13 years were analysed. Over a third of participants had obvious caries experience. Mean utility scores for CARIES-QC-U and CHU9D were 0.76 and 0.91 respectively. Missing data was low for both instruments. Floor and ceiling effects were greater for CARIES-QC-U. Internal consistency was acceptable for both instruments. Correlation between utilities of CARIES-QC-U and CHU9D was weak at 0.35. Correlation between clinical caries experience and utilities from CARIES-QC-U was negative (r=-0.09) and stronger than with CHU9D (r=-0.02). Correlations between dimensions within the instruments were weaker than anticipated. Small, statistically significant effects were seen for both instruments and the decayed (D) component of DMFT, though this was stronger with CARIES-QC-U. The burden of caries was reflected in participant utility scores. Whilst both PBMs performed well psychometrically, CARIES-QC-U demonstrated greater ability to capture impacts related to dental caries, indicating better suitability for caries research than CHU9D.

Abstract Background Current evidence in cariology teaching is not consistently reflected in paediatric dentistry in the United Kingdom (UK). Many dental schools are not consistently teaching biological approaches to caries management, with outdated or complex methods being taught outwith the purview of general dental practitioners. This scoping review aimed to map current guidelines on the management of caries in children and young people. This is part of a work package to inform the consensus and development of a UK-wide caries management curriculum for paediatric dentistry. Methods A search of electronic databases for peer reviewed literature was performed using Cochrane Library, MEDLINE via PubMed, TRIP Medical Database and Web of Science. Hand searching was undertaken for grey literature (citations of sources of evidence, websites of global organisations and Google Web Search™ (Google LLC, California, USA). Results from databases were screened independently, concurrently by two reviewers. Full texts were obtained, and reviewers met to discuss any disagreement for both database and hand searching. Results This review identified 16 guidelines suitable for inclusion. After quality appraisal, eight were selected for synthesis and interpretation. Key themes included the shift towards selective caries removal and avoidance of complete caries removal unless in specific circumstances in anterior teeth. For “early lesions” in primary and permanent teeth with and without cavitation, several guidelines recommend biological management including site specific prevention and fissure sealants. Conclusions This review mapping current cariology guidelines for children and young people found gaps in the literature including classification of early carious lesions and management of early cavitated lesions. Areas identified for further exploration include integration of biological caries management into treatment planning, selective caries removal and whether pulpotomy is specialist-level treatment, requiring referral. These results will inform consensus recommendations in the UK, using Delphi methods.

BACKGROUND:Little information on young people's and adults' views and experiences on decision-making for managing compromised first permanent molars (cFPM) exists. AIM:To establish young people's and adults' views and experiences of decision-making for managing cFPM. DESIGN:Face-to-face (online) semi-structured interviews were undertaken using an iteratively designed topic guide. Participants aged 12-65 were purposively sampled with recruitment from different dental clinics (three primary care, an out-of-hours emergency and one dental hospital). Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. RESULTS:Three themes were generated from young people's interviews (n = 9): (i) influencing factors; (ii) long-term considerations; and (iii) shared decision-making. Three themes were generated from adults' interviews (n = 13): (i) influences that affect decisions; (ii) perceptions of the specialist's role; and (iii) importance of shared decision-making for children and young people. CONCLUSION:Several factors influenced decision-making; for young people, professional opinions were important, and parental/peer influences less so. For adults, it was based on decisions on their prior experiences. Adults felt young people were abnormal if referred to a specialist. Young people wanted autonomy in decision-making to be respected; in reality, their views were rarely heard. There is potential to increase young people's involvement in shared decision-making for cFPM, which aligns with their aspirations.

Aim to compare two-year clinical success rates of caries management in children (Hall Technique HT, Nonrestorative caries treatment NRCT, Conventional restorations CR), and to evaluate pain perception, behaviour, technique acceptability by patients, parents and dentists. Methods 122, 3-8-year-olds were enrolled in 2-year parallel group randomised controlled trial (CR, n = 52, HT, n = 35, NRCT, n = 35). Caries was recorded using Nyvad criteria to measure clinical success/ failure rates. Child's pain perception (Visual Analogue Scale of Faces), child behaviour (Frankl scale), parents' and dentists' treatment opinions (5-point Likert scale) were assessed. Statistical analysis included Chi-square, non-parametric Kruskal-Wallis, Bonferroni-corrected Mann-Whitney U tests (p < 0.05), absolute risk reduction (ARR) and number needed to treat (NNT). Results After two years, with 116 participants, clinical success rates were: CR=60.8 % (n = 31), HT=93.8 % (n = 30), NRCT=42.5 % (n = 14) (p < 0.001). Major/minor failure rates differed: CR=17.6 % (n = 9) / 21.6 % (n = 11); HT=6.2 % (n = 2)/ 0 %, NRCT=33.3 % (n = 11)/ 24.2 % (n = 8), (p < 0.05). When comparing HT to CR, ARR = 0.33; NNT= 3 (95 % CI 0.02 -0.58); NRCT to CR, - no observed benefit from NRCT. More than 70 % of children demonstrated "positive/definitely positive" behaviour during treatment. Pain intensity was "very low/low" in 92.3 % of cases for CR, 88.6 % for HT, and 77.1 % for NRCT . NRCT was "very easy" to perform for 82.9 % of participants, compared to 42.3 % for CR and 17.1 % for HT (p < 0.05). CR were reported to take longer than NRCT and HT (p < 0.05). Conclusion Clinical success rates of HT were superior to CR and NRCT. All treatment techniques were well tolerated by children, CR was more time-consuming and HT - technically more difficult to perform. Clinical significance caries management in primary molars can be successfully performed using minimal intervention, particularly, sealing in caries lesions with Hall technique. NRCT can prevent caries progression when adequate access to mechanical plaque disruption and fluoride is provided. However, occasional fluoride application, and uncontrolled toothbrushing with fluoride toothpaste cannot replace restorative procedures.

BACKGROUND:Dental caries is the world's most prevalent disease. Untreated caries can cause pain and negatively impact psychosocial health, functioning, and nutrition. It is important to identify cost-effective, easy-to-use agents, which can prevent or arrest caries. This review evaluates silver diamine fluoride (SDF). OBJECTIVES:To assess the effects of silver diamine fluoride for preventing and managing caries in primary and permanent teeth (coronal and root caries) compared to any other intervention including placebo or no treatment. SEARCH METHODS:We searched CENTRAL, MEDLINE, Embase, Cochrane Oral Health's Trial Register and two clinical trials registers in June 2023. SELECTION CRITERIA:We included randomised controlled trials (RCTs), with parallel-group or split-mouth design, in children and adults (with or without carious lesions) that compared SDF with placebo or no treatment; different frequencies, concentrations or duration of SDF; or any other intervention. DATA COLLECTION AND ANALYSIS:We used standard methodological procedures expected by Cochrane, and GRADE to assess the certainty of the evidence. We collected data for primary caries prevention (change in caries increment), arrest of carious lesions, secondary prevention of caries (lesions do not progress from initial classification), adverse effects, dental pain or sensitivity, and aesthetics at the end of study follow-up. MAIN RESULTS:We included 29 RCTs (13,036 participants; 12,020 children, 1016 older adults). We summarise outcome data for the five most clinically relevant comparisons. All studies included high risks of bias, and some findings were imprecise (e.g. because of small sample sizes). SDF versus placebo or no treatment (14 studies; 2695 children, 905 older adults) Compared to placebo or no treatment, SDF may help prevent new caries in the primary dentition (1 study, 373 participants), or on the coronal surfaces of permanent dentition (1 study, 373 participants) but the evidence is very uncertain. SDF likely prevents new root caries (mean difference (MD) -0.79 surfaces, 95% confidence interval (CI) -1.40 to -0.17; 3 studies, 439 participants; moderate-certainty evidence). SDF may help arrest caries in the primary dentition (MD 0.86 surfaces, 95% CI 0.39 to 1.33; 2 studies, 841 participants; low-certainty evidence) and the permanent dentition (coronal: 1 study, 373 participants; root: 1 study, 158 participants) but the evidence is very uncertain. The evidence is very uncertain for secondary prevention of caries (primary dentition: 1 study, 128 participants; permanent dentition (coronal): 1 study, 663 participants), for adverse effects (5 studies, 1299 participants), and aesthetics (1 study, 43 participants). Different approaches to SDF application (5 studies, 1808 children) Studies compared different frequencies or intervals of application, different concentrations of SDF, and different durations of treatment. Some studies included multiple comparisons of different approaches. Because of the different approaches, we could not combine findings from these studies. Due to very low-certainty evidence, we were unsure whether any approach to SDF application was better than another for caries arrest (4 studies, including 8 comparisons of different approaches, 1360 participants); secondary prevention of caries (1 study, 203 participants), or led to differences in adverse effects (3 studies, 1121 children) or aesthetics (1 study, 119 children). SDF versus fluoride varnish (8 studies, 2868 children, 223 older adults) Compared to flouride varnish, SDF may result in little or no difference to the prevention of new caries in the primary dentition (MD 0.00, 95% CI -0.26 to 0.26; 1 study, 434 participants; low-certainty evidence). The evidence is very uncertain for this outcome measure in the permanent dentition (coronal: 1 study, 237 participants; root: 1 study, 100 participants; very low-certainty evidence). Due to very low-certainty evidence, we were unsure whether or not there were any differences between flouride varnish (applied weekly for three applications) and SDF for caries arrest and secondary prevention of caries in the primary dentition (1 study, 309 participants). Similarly, we were unsure of adverse effects (3 studies, 980 children), dental pain or sensitivity (1 study, 62 children), or aesthetics (1 study, 263 children). SDF versus sealants and resin infiltration (2 studies, 343 children) Very low-certainty evidence in this comparison meant we were unsure if either treatment was better than the other for primary prevention of caries in permanent dentition (coronal: 1 study, 242 participants), or adverse effects (2 studies, 336 participants). SDF versus atraumatic restorative treatment (ART) with glass ionomer cement (GIC) or GI material (4 studies, 610 children) Very low-certainty evidence in this comparison meant we were unsure if either treatment was better than the other at arresting caries in the primary dentition (1 study, 143 participants). We were also unsure whether there were any differences between treatments in adverse effects (3 studies, 482 participants), dental pain or sensitivity (1 study, 234 participants), or aesthetics (2 studies, 248 participants). AUTHORS' CONCLUSIONS:In the primary dentition, evidence remains uncertain whether SDF prevents new caries or progression of existing caries compared to placebo or no treatment, but it may offer benefit over placebo or no treatment in caries arrest. Compared to placebo or no treatment, SDF probably also helps prevent new root caries. However, the evidence is uncertain for other caries outcome measures in this dentition and in all caries outcomes for coronal surfaces of permanent dentition. Compared to flouride varnish, SDF may offer little or no benefit in preventing new caries in the primary dentition, but the evidence is very uncertain for other caries outcome measures in the primary dentition and for preventing new caries in the permanent dentition. We were unable to establish whether one SDF treatment approach was better than another, or how SDF compared to other treatments, because of very low-certainty evidence. The impact of SDF staining of teeth was poorly reported and the evidence for adverse effects is very uncertain. Additional well-conducted studies are needed. These should measure the impact of staining and be analysed to take account of clustering issues within participants.

Background This longitudinal study using qualitative methodology aims to investigate the perceptions, and implementation, of evidence-based guidelines into practice among new dental graduates (NDGs) during their transition from university into professional practice, by identifying factors that influence the adoption of evidence-based practice (EBP) in dental practice. Methods The study invited NDGs from one UK dental school ( N = 66) and employed longitudinal, multiple qualitative methodologies for data collection, throughout the participants’ Vocational Dental Training (VDT) year. Initial interviews (Interview 1) conducted upon graduation and follow-up interviews (Interview 2) carried out between six and nine months into professional practice were combined with participants longitudinal audio diaries (LADs) recorded between the interviews. The study. Results A total of 12 NDGs agreed to participate. For Interview 1, twelve participants were interviewed, seven of whom agreed to participate in Interview 2 and six recorded the LADs. Interview 1 exposed diverse views among NDGs about EBP, acknowledging its significance but facing obstacles in implementation due to time and financial constraints. They intended to use evidence selectively, often aligning with trainers’ or NHS treatment options, while hesitating to fully embrace EBP in a busy dental practice. During VDT, LAD entries showed initial enthusiasm for EBP, but integrating evidence-based guidelines within the NHS system led to pragmatic treatment decisions, balancing gold-standard and cost-effective options. Over time, NDGs became more comfortable with alternative treatments, considering patients’ financial constraints, yet they expressed frustration with external pressures limiting their clinical decision-making autonomy. In Interview 2, after six to nine months in practice, NDGs exhibited mixed attitudes towards EBP. Some actively used dental guidelines like SDCEP, others associated EBP with hi-tech or expensive materials, while others would thought to rely on colleagues’ recommendations. None consistently sought direct evidence for treatment decisions. Conclusion NDGs’ attitudes towards EBP changed and became more negative over their first year in professional practice, leading to challenges in their applying it. It questions the assumption that teaching EBP during undergraduate education ensures its implementation. Further understanding the influences on the development of attitudinal challenges will help to devise effective strategies for fostering lifelong learning and supporting evidence-based practice in dentistry.

INTRODUCTION:Interest is growing in the potential of artificial intelligence (AI) chatbots and large language models like OpenAI's ChatGPT and Google's Gemini, particularly in dental education. To explore dental educators' perceptions of AI chatbots and large language models, specifically their potential benefits and challenges for dental education. MATERIALS AND METHODS:A global cross-sectional survey was conducted in May-June 2023 using a 31-item online-questionnaire to assess dental educators' perceptions of AI chatbots like ChatGPT and their influence on dental education. Dental educators, representing diverse backgrounds, were asked about their use of AI, its perceived impact, barriers to using chatbots, and the future role of AI in this field. RESULTS:428 dental educators (survey views = 1516; response rate = 28%) with a median [25/75th percentiles] age of 45 [37, 56] and 16 [8, 25] years of experience participated, with the majority from the Americas (54%), followed by Europe (26%) and Asia (10%). Thirty-one percent of respondents already use AI tools, with 64% recognising their potential in dental education. Perception of AI's potential impact on dental education varied by region, with Africa (4[4-5]), Asia (4[4-5]), and the Americas (4[3-5]) perceiving more potential than Europe (3[3-4]). Educators stated that AI chatbots could enhance knowledge acquisition (74.3%), research (68.5%), and clinical decision-making (63.6%) but expressed concern about AI's potential to reduce human interaction (53.9%). Dental educators' chief concerns centred around the absence of clear guidelines and training for using AI chatbots. CONCLUSION:A positive yet cautious view towards AI chatbot integration in dental curricula is prevalent, underscoring the need for clear implementation guidelines.

Background: The presence of dental caries impacts on children's daily lives, particularly among those living in deprived areas. There are successful interventions across the United Kingdom for young children based on toothbrushing with fluoride toothpaste. However, evidence is lacking for oral health improvement programmes in secondary-school pupils to reduce dental caries and its sequelae. Objectives: To determine the clinical and cost effectiveness of a behaviour change intervention promoting toothbrushing for preventing dental caries in secondary-school pupils. Design: A multicentre, school-based, assessor-blinded, two-arm cluster randomised controlled trial with an internal pilot and embedded health economic and process evaluations. Setting: Secondary schools in Scotland, England and Wales with above-average proportion of pupils eligible for free school meals. Randomisation occurred within schools (year-group level), using block randomisation stratified by school. Participants: Pupils aged 11-13 years at recruitment, who have their own mobile telephone. Interventions: Two-component intervention based on behaviour change theory: (1) 50-minute lesson delivered by teachers, and (2) twice-daily text messages to pupils' mobile phones about toothbrushing, compared with routine education. Main outcome measures: Primary outcome: presence of at least one treated or untreated carious lesion using DICDAS4-6MFT (Decayed, Missing and Filled Teeth) in any permanent tooth, measured at pupil level at 2.5 years. Secondary outcomes included: number of DICDAS4-6MFT; presence and number of DICDAS1-6MFT; plaque; bleeding; twice-daily toothbrushing; health-related quality of life (Child Health Utility 9D); and oral health-related quality of life (Caries Impacts and Experiences Questionnaire for Children). Results: Four thousand six hundred and eighty pupils (intervention, n = 2262; control, n = 2418) from 42 schools were randomised. The primary analysis on 2383 pupils (50.9%; intervention 1153, 51.0%; control 1230, 50.9%) with valid data at baseline and 2.5 years found 44.6% in the intervention group and 43.0% in control had obvious decay experience in at least one permanent tooth. There was no evidence of a difference (odds ratio 1.04, 95% confidence interval 0.85 to 1.26, p = 0.72) and no statistically significant differences in secondary outcomes except for twice-daily toothbrushing at 6 months (odds ratio 1.30, 95% confidence interval 1.03 to 1.63, p = 0.03) and gingival bleeding score (borderline) at 2.5 years (geometric mean difference 0.92, 95% confidence interval 0.85 to 1.00, p = 0.05). The intervention had higher incremental mean costs (1.02 pound, 95% confidence interval -1.29 to 3.23) and lower incremental mean quality-adjusted life-years (-0.003, 95% confidence interval -0.009 to 0.002). The probability of the intervention being cost-effective was 7% at 2.5 years. However, in two subgroups, pilot trial schools and schools with higher proportions of pupils eligible for free school meals, there was an 84% and 60% chance of cost effectiveness, respectively, although their incremental costs and quality-adjusted life-years remained small and not statistically significant. The process evaluation revealed that the intervention was generally acceptable, although the implementation of text messages proved challenging. The COVID-19 pandemic hampered data collection. High rates of missing economic data mean findings should be interpreted with caution. Conclusions: Engagement with the intervention and evidence of 6-month change in toothbrushing behaviour was positive but did not translate into a reduction of caries. Future work should include work with secondary-school pupils to develop an understanding of the determinants of oral health behaviours, including toothbrushing and sugar consumption, particularly according to free school meal eligibility.

OBJECTIVES:This multicentre, assessor-blinded, two-arm cluster randomized trial evaluated the clinical and cost-effectiveness of a behaviour change intervention promoting toothbrushing for preventing dental caries in UK secondary schools. METHODS:Pupils aged 11-13 years with their own mobile telephone attending secondary schools with above average free school meals eligibility were randomized (at year-group level) to receive a lesson and twice-daily text messages or to usual care. Year-groups (n = 84) from 42 schools including 4680 pupils (intervention, n = 2262; control, n = 2418) were randomized. RESULTS:In 2383 participants with valid data at baseline and 2.5 years, the primary outcome of presence of at least one treated or untreated carious lesion (D4-6 MFT [Decayed, Missing and Filled Teeth] in permanent teeth using International Caries Detection and Assessment System) was 44.6% in the intervention group and 43.0% in control (odds ratio [OR] 1.04, 95% CI 0.85-1.26, p = .72). There were no statistically significant differences in secondary outcomes of presence of at least one treated or untreated carious lesion (D1-6 MFT), number of D4-6 MFT and D1-6 MFT, plaque and bleeding scores or health-related- (Child Health Utility 9D) or oral health-related- quality of life (CARIES-QC). However, twice-daily toothbrushing, reported by 77.6% of pupils at baseline, increased at 6 months (intervention, 86.9%; control, 83.0%; OR 1.30, 95% CI 1.03-1.63, p = .03), but returned to no difference at 2.5 years (intervention, 81.0%; control, 79.9%; OR 1.05, 95% CI 0.84-1.30, p = .69). Estimated incremental costs and quality-adjusted life-years (QALYs) of the intervention, relative to control, were £1.02 (95% CI -1.29 to 3.23) and -0.003 (95% CI -0.009 to 0.002), respectively, with a 7% chance of being cost-effective (£20 000/QALY gained threshold). CONCLUSION:There was no evidence of statistically significant difference for caries prevalence at 2.5-years. The intervention's positive 6-month toothbrushing behaviour change did not translate into caries reduction. (ISRCTN 12139369). COVID-19 pandemic adversly affected follow-up.

There is limited evidence to support optimal patient-centered management for compromised first permanent molars (cFPM) in children. Based on an online discrete choice experiment (DCE), this study elicits UK adult general population preferences and calculates willingness to pay (WTP) for pathways to manage cFPM. The DCE was designed with information from semistructured interviews and literature reviews, as well as focus groups with an expert panel of dentists, citizens, and policy makers. A statistically optimal D-efficient design generated 18 choice tasks, split across 2 blocks. Each respondent answered one block of 9 tasks to reduce survey fatigue. Choice tasks varied across 5 attributes: type of treatment, provider of care, who makes the management decision, number of future visits avoided, and cost. An opt-out was included (no treatment). Conditional logit models (fixed effects) were used for data analysis, and marginal WTP for each attribute level was calculated. An overall 430 respondents completed the DCE. Respondents valued children receiving care as compared with not. Restoring a cFPM was valued equally to spontaneous or orthodontic gap closure. In contrast, having a partial gap, prosthetic replacement with a bridge, or a full unit gap was valued less than restoration or full gap closure. General dentists were preferred to dentists with enhanced skills, but there was no evidence of a preference for general dentists over specialists in pediatric dentistry. Respondents preferred to be wholly or partly involved in the decision-making process as opposed to the dentist making the decision alone. Respondents preferred less costly treatments and the avoidance of future dental work. Dental care service providers must consider service user preferences for health and nonhealth outcomes in any service redesign. Furthermore, the results provide marginal WTP estimates that can be used to value dental care services.