Bexhill Hospital

increases the likelihood of experiencing dental caries. 'School readiness' describes the likely ease with which a child transitions to formal schooling, and is assessed via intellectual, social and physical development indicators and influenced by early life experiences, home environment and parenting ability. Children are assessed as 'emerging' (underperforming), 'expected' or 'exceeding' during their reception year. These data, with data from the national Oral Health Survey, were linked to a birth cohort of children in Bradford, UK to describe the association between caries experience and school readiness in five-yearold children. Analysis showed that 'emerging' children had higher odds of experiencing caries than those achieving 'expected' scores. Children 'exceeding' expected scores had lower odds of experiencing caries. Previous research has shown that there is an association between caries experience and poor academic performance. From this, it has been inferred that missed schooling due to dental pain or dental appointments is a causative factor. This study, however, 'indicates (that) poor academic outcomes are not causal through absenteeism due to dental problems' .

increases the likelihood of experiencing dental caries. 'School readiness' describes the likely ease with which a child transitions to formal schooling, and is assessed via intellectual, social and physical development indicators and influenced by early life experiences, home environment and parenting ability. Children are assessed as 'emerging' (underperforming), 'expected' or 'exceeding' during their reception year. These data, with data from the national Oral Health Survey, were linked to a birth cohort of children in Bradford, UK to describe the association between caries experience and school readiness in five-yearold children. Analysis showed that 'emerging' children had higher odds of experiencing caries than those achieving 'expected' scores. Children 'exceeding' expected scores had lower odds of experiencing caries. Previous research has shown that there is an association between caries experience and poor academic performance. From this, it has been inferred that missed schooling due to dental pain or dental appointments is a causative factor. This study, however, 'indicates (that) poor academic outcomes are not causal through absenteeism due to dental problems' .

Direct pulp capping (DPC) has been considered with some scepticism by practitioners in the past, due to reported unpredictable outcomes. Newer techniques, materials and a better understanding of pulpal biology have, however, focused attention again on the procedure. Using New York (USA) health insurance data from 2006 to 2019, 4,136 unique teeth which received DPC were followed. Overall survival rate of the procedure (DPC to either root canal therapy [RCT] or extraction) was 83.2% over a mean observation period of 52 months. Of the 16.8% that experienced failure (n = 694), 58.4% received RCT and 41.6% were extracted. Failure was most likely in the first year following DPC. Tooth survival following DPC was 92.9% over a six-year follow-up period. Adjusted analyses showed that DPC on molar teeth was less likely to fail but when it did, extraction was more likely to follow, perhaps because of limited access to molar RCT. Same-day placement of a permanent restoration was a significant predictor of DPC procedure survival.

Reviewing the history of primary care dentistry from ancient Egypt to the present, with glimpses into future possibilities, the author takes a narrow, first world, mechanically interventionist view. Whilst recognising that part of the purpose of primary care (from the Alma Ata declaration, 1978) is 'the maintenance of health (and) the prevention of disease' and that one of the goals is to 'promote good oral hygiene habits, ' the author presents a picture of today dominated by intervention (albeit 'minimally') and the rise of digital dentistry presenting opportunities for improving patient comfort (presumably during interventions). There is a current need for research to be carried out in general practice, to assess the effectiveness and 'performance of dental restorations, devices and techniques' in the real world, rather than in the 'ideal circumstances' of an academic environment. The future is characterised by further digital developments in scanning, 3D printing and the expanding use of teledentistry. Artificial intelligence will be used to improve workflows, streamline dental procedures and virtual treatment planning. There is no mention, in the author's primary care future, of the development of preventive strategies, managing behaviour change or liaising with other health care professionals to improve general health.

The argument for and against the imposition of fines. Recent studies show that patient non-attendance rates vary between 5% and 25%. Norway has a universal, tax-financed healthcare system and a standard non-attendance fee (currently €139) has been applied since 2009. Since 2009, the Norwegian government has instigated five public consultations on non-attendance fees in healthcare. Reviewing comments from these consultations, it appears that such fees are broadly supported and accepted by the public. However, a number of objections were identified: • There is little evidence that such fees are effective and do not act as a motivational tool -there may be other reasons for non-attendance, such as unforeseen personal crises • In line with other studies, fees were considered resource-demanding to implement • Socially vulnerable groups, with an increased risk of poor health, are likely to be unequally disadvantaged by non-attendance fees • Due to the additional income, there is a perverse incentive for providers not to seek alternatives strategies to reduce non-attendance.