RETURN Randomized Controlled Trial to Increase Adult Routine Dental Visits.

Abstract

Groups with low socioeconomic status are less likely to make planned dental visits even though routine attenders have fewer caries and less tooth loss. Because behavioral interventions positioned in urgent dental care may improve health and inequalities, RETURN, which involved a nurse conversation supported by videos, booklets, and goal/action-plan setting, was developed. The objective of this study was to investigate the effectiveness of the RETURN intervention at increasing planned dental visits and lessening the oral health impact. Adults attending 14 National Health Service urgent dental services were recruited to a randomized controlled trial and followed up after 6, 12, and 18 mo. Co-primary outcomes were (1) planned visits at 12 mo as measured by Business Services Authority (BSA) data and (2) Oral Health Impact Profile (OHIP) summary score at 12 mo adjusted for baseline. Of the 1,176 consenting adults who were randomized, 591 were allocated to the RETURN group. More than half (55.2%, 315 intervention; 54.7%, 310 control) lived in the lowest Index Multiple Deprivation decile. RETURN participants had a 20% greater odds of planned care as recorded by the BSA at 12 mo (odds ratio [OR] = 1.21; 97.5% confidence interval [CI] = 0.86, 1.70; P = 0.217). There was a reduction (improvement) in OHIP scores at 12 mo in both groups (RETURN group, mean = -7.4, standard deviation [SD] = 12.9; control group, mean = -6.2, SD = 12.9). The least squares mean of the RETURN Modified Dental Anxiety Score decreased with time (anxiety improved) whereas it increased (worsened) in the control group (Modified Dental Anxiety Scale time and treatment group interaction = -0.01; CI = -0.03, 0.00; P = 0.027). RETURN participants had a more than 3 times greater odds of attempting to make an appointment, with the treatment effect increasing with time (at 18 mo: OR = 3.39; 95% CI = 1.83, 6.27; P = 0.0001). We are moderately certain RETURN produced small, consistently favorable effects on routine visits, oral health impact, and dental anxiety despite limited-service availability. RETURN also significantly increased attempts to make routine appointments even in a disadvantaged cohort. This supports integrating behavioral support alongside service reforms to support the transition into continuing care and the optimum use of resources.