People on low incomes are far less likely to book a routine dentist appointment, and this directly leads to more tooth loss, more pain, and more emergency hospital visits for dental problems. This matters because poor oral health is widespread and costly. When people avoid planned dental care, their problems escalate into acute crises that send them to A&E or GP surgeries, where they often receive antibiotics—contributing to antimicrobial resistance. The research team has identified a specific psychological technique, called Implementation Intentions, that helps people turn good intentions into concrete actions. They want to test whether a brief intervention delivered by dental nurses during an urgent care visit can nudge patients to book and attend a follow-up check-up. If the trial succeeds, the intervention could be rolled out across NHS urgent dental services at low cost. It would shift patients from crisis-driven, expensive care toward preventive, planned care—reducing pressure on emergency services, cutting unnecessary antibiotic prescriptions, and improving long-term oral health for the people who currently suffer most. The study will also compare three methods of collecting clinical data, which could improve how dental outcomes are measured in future research.
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Background Adults with low socio-economic (SES) backgrounds are less likely to use dental services for planned dental care. There is good evidence that this is a reason why they have fewer teeth, experience more toothache and have higher reported impacts such as difficulty eating. Since poor oral health is a common problem, this is a significant health issue. It also increases cost to the NHS in the inappropriate use of general practice/ A&E/ hospital in-patient care for dental problems. Acute dental problems often also result in antibiotic prescriptions and this adds to the problem of antimicrobial resistance. We have 3 research questions: 1. What are the most common barriers to planned dental care, and personal strategies which can help overcome them? 2. Can an opportunistic intervention for urgent care users be successfully delivered in NHS dental practices and Dental Hospitals? 3. Is a psychological intervention effective and cost-effective at increasing the uptake of planned dental care? Research Plan Developing the intervention (Work Package 1) Our intervention will have both persuasive and behavioural enactment components, but will mainly feature an Implementation Intentions (IIs) intervention. This approach is selected because 1) it is brief, and simple to administer; 2) Implementation Intentions are known to assist people to overcome significant barriers to behaviour change; and 3) IIs can achieve an improvement in uptake of planned care appointments to the order of 10%. The intervention will be delivered by dental nurses supported by intervention material on a Tablet PC, with further intervention material supplied to patients with an online link sent by text message; or in a booklet/leaflet - according to patients preference. In the first phase of the research, we will undertake ethnographic work to help determine the most salient barriers patients are likely to identify; and the IIs which are likely to be both acceptable and effective. This will also help generate relevant images, quotes and narratives for the intervention material which are in accord with the in group identity of the population targeted. We will then iteratively test and further develop the intervention material and delivery format during a pilot phase by undertaking qualitative interviews with dental staff and patients. Testing the intervention (Work Package 2) We will undertake a 9 month feasibility study involving 60 patients randomised to intervention and control groups. The feasibility study will include a comparison of three different methods of collecting clinical outcome data: 1) dental practice clinical records; 2) photographs and 3) a clinical examination by a trained researcher. We will then recruit 1,180 urgent dental care users to a RCT of a psychological intervention at 47 dental practices with Urgent Dental Care contracts and a Dental Hospital. Based on previous data we estimate that 30% of urgent dental care users return for planned dental care within 12 months. Based on a minimum clinically significant difference of 10 percentage points (i.e. an improvement to 40% of patients attending a dentist), our sample size calculation gives 80% power at α=0.025 (to allow for joint primary outcomes) to detect this improvement in the intervention group, while allowing for a potential contamination between groups of 10% and 5% unavailable outcome data. Co-primary outcomes are attendance at a dental practice for a planned care appointment within 12 months (routinely available Business Health Services Authority data), and a summary score of self-reported oral health impact at 12 months collected by telephone/e mail follow up. Secondary outcomes include these measures at 18 months, as well as clinical outcomes (number of teeth and number of untreated, decayed teeth); and the use of NHS services for acute dental problems and antibiotic prescriptions and/or analgesics. Regression analysis will allow us to investigate
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