A seal of approval for tooth decay treatment

Aberdeen research prompts change in dental policy benefitting thousands of Scottish children

Dental decay in young children is an increasing problem that can severely affect oral health into adulthood. University of Aberdeen research directly led to a change in the Scottish Dental Contract which has doubled the number of children receiving fissure sealants. These are protective plastic coatings which are applied to the biting surfaces of the back teeth. The sealant forms a hard shield that stops food and bacteria getting into the tiny grooves in the teeth and causing decay.

The University of Aberdeen’s Health Services Research Unit conducted a randomised trial looking at the effectiveness of a strategy to improve use of fissure sealants. Fissure sealants reduce decay in children’s teeth but, before this research, dentists rarely used them. The trial examined a fee-for-service program in dental care where each dentist received a sum of money per tooth sealed.

The trial demonstrated that fee payment was associated with an increase in fissure sealant use. This finding led to a change in the Scottish Dental Contract, which now includes a fee-for-service for fissure sealants in children over 11 years old.

Since 2008, guidance documents from the NHS Department of Health and the Scottish Dental Clinical Effectiveness Programme for dentists have recommended placement of fissure sealants on children above 11-years-old. Since the introduction of the fee, over 37,000 children per year in Scotland have received fissure sealants. This figure is double the number of children receiving sealants before the policy change and equates to some 150,000 children receiving the sealants since January 2008.

Placing fissure sealants in teeth at an early age has benefits in preventing tooth decay in later life and we are pleased to have played a part in ensuring that more Scottish children benefit from this treatment

Professor Craig Ramsay

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• Professor Craig Ramsay's staff profile

Key publications

• Grimshaw JM, Thomas RE, MacLennan GS, Fraser C, Ramsay CR, Vale L, Whitty P, Eccles MP, Matowe L, Shirran L, Wensing M, Dijkstra R, Donaldson C. (2004). Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess 8(6):1-72. This research, led from the University of Aberdeen’s HSRU was, and continues to be, the most comprehensive review of guideline dissemination and implementation strategies
• Clarkson JE, Turner S, Grimshaw JM, Ramsay CR, Johnston M, Scott A, Bonetti D, Tilley CJ, Maclennan G, Ibbetson R, MacPherson L, Pitts NB. (2008). Changing clinicians’ behavior: a randomized controlled trial of fees and education. J Dent Res; 87(7):640-4. This paper reports the ERUPT trial referred to in this case study. It continues to be the largest trial ever undertaken of a fee-for-service intervention in primary dental care

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