Table 2 A simplified version of the events’ matrix

Patient Information Sheet (PIS) was given

X

All patients who were accepted for dental care had radiograph examination according to their needs. This is a standard process and was not dependent on participation in this study

X

Consent- a signed copy was given to the patient

X

Part A questionnaire: Screening data: HADS ( A and D > 10) and MDAS: (19 or above)

X

If eligible: Letter to GMP/GDP

X

If not eligible and high scores of HADS a letter to GMP

X

If eligible: Randomisation

In the intervention group: EH provided care for all the patients

In the TAU group: Patients were allocated to various members of staff for care planning sessions

X

Oral health needs and caries risk assessment: In this part, the radiographs findings (radiographs that was taken when patients attended the department at visit 1) complemented the oral finings when an oral health examination took place

In both groups, a personalised prevention program was offered as a referral to the SSCD dental therapist and hygienist at the same visit was introduced on the 08 November 2017

In the intervention group:

There were discussions about:

• MIOC and MID principles

• Patients’ expectations/needs/wishes

• Provisional nature of the provided care plan

• Behavioural management and CS techniques

Clinical examinations (if possible):

• Tooth sensibility (vitality) test:

Measures that were used:

• A clear visual-tactile evaluation when possible: Decayed, Missing, Filled Teeth/Surfaces (DMFT/DMFS) scores was calculated (according to ADHS 2009 criteria)

• Periodontal status (2009 ADHS criteria)

• Plaque score

• Basic Periodontal Examination (BPE) when possible

In the TAU group:

There were discussions about:

• Patients’ expectations

• Provisional nature of the provided care plan

• Behavioural management and CS techniques

Clinical examinations (if possible):

• Decayed, Missing, Filled Teeth/Surfaces (DMFT/DMFS)

• Basic Periodontal Examination (BPE) (introduced on the 08 November 2017) at the same visit

In both groups, at the care planning sessions, a provisional care plan was discussed and agreed upon

X

Treatment sessions:

In the intervention group:

EH provided care for ‘preventive oral health related’ and treatment sessions

At each visit, EH gave OHI and followed up patients’ commitments to OH practises. EH used behavioural technique management (such as relaxation techniques by using controlled breathing) during these sessions

During the sedation:

1^st sedation appointment scale and polish (Professional Mechanical Plaque Removal [PMPR]) as well as dental treatment

• The restorative treatment protocol (MID):

A. Started with teeth that presented with the deepest lesions first: partial caries removal (PCR) with rubber dam to protect the pulp-dentine complex

B. Monitored initial carious lesions and poor prognosis teeth

• BPE and minimum periodontal care

At the recovery, information to the patients:

• Reinforced the importance of OHI and discussed about MID and MIOC

• What the continuation of the care plan would be (e.g., to continue to restore teeth with deepest lesions at the following visits)

• Monitor prognosis of teeth

In the TAU (the control arm), SSCD staff or diploma students in SSCD provided care for the patients

The common procedures were:

Pre sedation:

• The care plan was dictated by previous care plan. At sedation appointment the care plan could also be influenced by the patient especially when presented with symptomatic teeth and the practitioner’s preference

During the sedation:

• 1^st sedation appointment: usually scale and polish or relieve of pain (e.g., extractions of appropriate teeth if the patient is in pain)

• with exception by one dental therapist, the caries management was by complete excavation (the hardness of dentine is determining the completion of excavation)

Recovery:

• To be allocated to either a member of staff or a SSCD postgraduate student

X

Both groups were seen by the dental therapists/dentists in the SSC department

1. The 'study questionnaire' had 3 parts:

Part A: demographic information and MDAS and HADS (screening questionnaires) that was given at the beginning of the study

Part B of the questionnaire (with questions based on ADHS, 2009) (O’ Sullivan et al., 2011) documented OHR behaviours (such as toothbrushing) and QoL (measured by Oral Health Impact Profile [OHIP 14])

Whereas part C sought participants’ views ( in the adapted version of Treatment Evaluation Inventory [TEI]) (Newton & Sturmey, 2004) post completion of care (≥ 6 months)

The entire questionnaire could take approximately 35 min to complete

All 3 parts of the questionnaire (A, B and C) and an oral health assessment was conducted by a member of SSCD staff

2. For both arms, the clinical measurements

• Full charting (for EH to calculate DMFT/DMFS)

• BPE

• Plaque score (used disclosing tablets)

If treatment needed, a staff would review the provisional care plan and offer CBT

If no further treatment was required, the patient was referred back to the GDP in both arms

• In the intervention group, an additional letter that detailed the MID/MIOC principles and suggested a recall time based on the individual’s risk/susceptibility (e.g., monitoring the integrity of the sealants) and management of the future oral health diseases was sent to the patient’s GDP. When applicable, the letter also suggested to review the provisional care plan considering rehabilitation and replacement of missing teeth

The questionnaire can be sent by request.

X