Ruth Freeman

• PhD
• Managing Director at University of Dundee

Introduction Smile4life is Scotland's national oral health improvement programme for people experiencing homelessness, aimed at reducing oral health inequalities experienced by this population. This study forms part of an evaluation of how the Smile4life intervention was being implemented within Scottish NHS Boards. The aim was to investigate the i...

Introduction The COVID-19 pandemic resulted in a series of significant changes and adjustments within dentistry, as dental professionals dealt with temporary closures of dental practices, increased use of personal protective equipment, a reduction of clinical procedures, and extensions to training programmes. Recent research has illustrated the imp...

Introduction Recent cross-sectional surveys have shown the detrimental impact of COVID-19 on the health and well-being of dental practitioners and dental care professionals. This qualitative study complements the growing quantitative evidence base with an in-depth exploration of the lived experiences of those working in primary care dental teams in...

Objective To investigate the fatigue trajectory during a 6-month duration of the COVID-19 pandemic for dental health professionals in primary dental care and for those in training. Design A longitudinal intensive panel diary was conducted (July–December 2020) assessing weekly self-ratings of emotional fatigue. Setting Dental care services in Scot...

Background People experiencing homelessness have high levels of dental decay, oral cancer and poor oral health-related quality of life. The Scottish Government sought to address these issues by developing a national oral health improvement programme for people experiencing homelessness, named Smile4life. The aim was to investigate implementation be...

The aim of this study was to explore communication interactions and identify phases adopted by dental professionals with parents and their young children and to examine the hypothesis that successful social talking between the actors together with the containment of worries allows the formation of a triadic treatment alliance, which leads to achiev...

Background: The COVID-19 pandemic has placed increased demands on clinical staff in primary dental care due to a variety of uncertainties. Current reports on staff responses have tended to be brief enquiries without some theoretical explanation supported by developed measurement systems. Aim: To investigate features of health and well-being as an o...

Background A feasibility study was conducted to implement the T alk, I nstruct, P ractice, P lan and S upport (TIPPS) intervention for pregnant women to enhance infant birth weight in a conflict area in L ow- and M iddle- I ncome C ountries (LMIC). The decision tool, A process for De cision-making after P ilot and feasibility T rials (ADePT), exami...

Background The oral health promotion sessions for young children and parents in a clinical setting pose challenges to the dental team. Aim To apply PaeD‐TrICS (Paediatric dental triadic interaction coding scheme) to investigate the interaction of child, parent and dental nurse and determine the effect of nurse and parental behaviours on child part...

This is the 3rd Scottish Report on Oral Health in Prisons which is a part of the monitoring of the oral health and psychosocial needs of people in prison in Scotland from 2002 to 2019. In addition to assessing the oral and dental health of prisoners it supports the evaluation of policy change of transfer of responsibility of healthcare of prisoners...

This report an executive summary of the 3rd oral health and psychosocial needs assessment of people in prison in Scotland from 2002 to 2019. In addition to assessing the oral and dental health of prisoners it supports the evaluation of policy change of transfer of healthcare of prisoners from SPS to NHS in 2011 and the introduction of the Mouth Mat...

This chapter is a review of the effects of drugs and substance use upon oral health. It provides the latest WHO and FDI definition of oral health together with a brief description of the main oral diseases, i.e., dental caries and periodontal disease. It describes the effects of substance use and their physiological actions on teeth, oral mucosa an...

Effective communication forges the dentist-patient treatment alliance and is thus essential for providing person-centred care. Social rank theory suggests that shame, trust, communication and anxiety are linked together, they are moderated by socio-economic position. The study is aimed to propose and test an explanatory model to predict dental atte...

This article describes the process to create a framework to map services for people experiencing and/or at risk of becoming homeless. Using a participative and multi-agency approach the Reflexive Mapping Exercise (RME) was proposed to increase knowledge on what is available to address the health and social care needs of those experiencing homelessn...

Background: This is a protocol for a systematic review of the motivations and expectations of adult patients who seek orthodontic treatment. With the continuous improvement of orthodontic technique and rapid innovation of orthodontic appliances, more adults begin to consider orthodontic treatment. Appropriate motivations and realistic expectations...

Background: A feasibility study was conducted to implement the TIPPS intervention for pregnant women to enhance infant birthweight in a conflict area in a LMIC. The decision tool, ADePT examines the methodological factors, identified in a feasibility study, that may require modification for a full trial. Objectives: To use the ADePT decision tool...

Background: A feasibility study was conducted to implement the T alk, I nstruct, P ractice, P lan and S upport (TIPPS) intervention for pregnant women to enhance infant birthweight in a conflict area in L ow and M iddle I ncome C ountries ( LMIC). The decision tool, A process for De cision-making after P ilot and feasibility T rials (ADePT) examine...

Objective: To determine the characteristics of community-based oral health interventions for people experiencing homelessness. Basic research design: A scoping review was conducted, adhering to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses: Scoping Reviews) checklist. A search strategy was developed using MeS...

Background: The Filling Children's Teeth: Indicated Or Not? (FiCTION) randomised controlled trial (RCT) aimed to explore the clinical- and cost-effectiveness of managing dental caries in children's primary teeth. The trial compared three management strategies: conventional caries management with best practice prevention (C + P), biological managem...

Background: The lack of evidence for the effective management of carious lesions in children's primary teeth has caused uncertainty for the dental profession and patients. Possible approaches include conventional and biological management alongside best practice prevention, and best practice prevention alone. The FiCTION trial assessed the effecti...

Objective: To test a theoretical mediation model and investigate whether drug use and/or dental anxiety act as mediating factors between depression and dental decay experience among prisoners. Method: A cross-sectional survey was conducted on a convenience sample of 300 prisoners across three prison establishments in Scotland. Depression and den...

Introduction Dental anxiety is common and causes symptomatic use of oral health services. Objectives The aim was to study if a short-term virtual reality intervention reduced preoperative dental anxiety. Methods A randomized controlled single-center trial was conducted with 2 parallel arms in a public oral health care unit: virtual reality relaxa...

Background Historically, lack of evidence for effective management of decay in primary teeth has caused uncertainty, but there is emerging evidence to support alternative strategies to conventional fillings, which are minimally invasive and prevention orientated. Objectives The objectives were (1) to assess the clinical effectiveness and cost-effe...

It is known that extreme dental fear and drug use affect oral health and access to dental services, what is not known is how depression is related to drug use and dental anxiety and how they impact upon decayed and missing teeth for people in custody. The aim was to determine the impact of depression, dental anxiety and drug use upon prisoner’s exp...

Aim To explore the time taken and the types of communication strategies used by dental health professionals (DHPs) when interacting with and providing fluoride varnish and oral health advice to children with their parents. Methods A video observational study was conducted to explore the types of communication strategies used by DHPs when interactin...

A psychosocial needs assessment survey was conducted across Scottish prisons as part of the Scottish Oral Health Improvement Prison Programme’s (SOHIPP) development of the ‘Mouth Matters’ oral health intervention. The survey highlighted, that people in custody had a high prevalence of tooth decay and unmet treatment needs. Participants experienced...

Background: There is a paucity of research concerning paediatric dental consultations in primary care. This is potentially due to the difficulty of measuring the communication behaviours in the complex triadic consultations. The present study aims to describe the development and refinement of a coding scheme to record the triadic communication bet...

This chapter is a review of the effects of drugs and substance use upon oral health. (In press)

Objectives: To conduct a rapid review to identify any maternal and/or child oral health interventions implemented and/or tested in Middle East and North Africa (MENA) countries generally, and Lebanon, Palestine and Syria specifically, and to compile information on the relative effectiveness of these interventions. Methods: A systematic search wa...

The Smile4life RME is a mapping of existing and available services under eight areas of support. Using this collaborative and multi-agency approach, the Smile4life RME helps all practitioners create clear referral pathways for their clients. This document will increase accessibility and strengthen engagement with people who have multiple and comple...

Background: Prisoners have poorer dental health than non-prison populations. It is known that the prison environment can promote health and thus, policies, including access to dental care, are in place to promote health during imprisonment. Aim: Our aim was to conduct an oral health and psychosocial needs survey to identify the factors associated w...

Young homeless people make up nearly one-third of those experiencing homelessness. The need to provide an educative approach, to strengthen social interacting, and construct new knowledge to increase social inclusivity, is required. The aim of this qualitative exploration was to use critical consciousness as an educative tool, to co-design, impleme...

Aim to test the psychometric properties of an Arabic version of the Child Fear Survey Schedule‐Dental Subscale (CFSS‐DS) a using confirmatory factor analysis. Methods 2 convenience samples were obtained: Sample [1]: 600 boys (33%) and girls attending 4 public schools in Onizah and Sample [2] 800 girls attending 8 public schools in Buridah. The que...

It has been argued in paediatric dentistry whether or not we should have parent at presence during children's dental treatment. This presentation shows the important mediating role for parents to 'translate' the language for dental professionals and facilitating the consultations for very young children (under 6 years) in the preventive dental care...

Smile4life is an intervention aimed at improving the oral health of people experiencing homelessness in Scotland. The purpose of this research was to determine how this intervention was being translated from guidance into action. Data concerning Smile4life working practices were collected in three NHS Boards using participant observation. Fieldnote...

The aim of this research was to conduct an oral health and psychosocial needs assessment of a homeless population in Scotland to determine the levels of unmet need and provide recommendations for oral health improvement. A non-probability convenience sample of homeless people residing in seven Scottish Health Boards was collected. All consenting pa...

Introduction Communication skills are an integral component of dental undergraduate education. Due to the complex nature of these skills, didactic teaching methods used in other educational contexts can be limited. Interactive and participative methods rooted in modern adult learning theories, such as Forum Theatre, may be more effective in the tea...

Background The promotion of twice yearly application of fluoride varnish (FVA) to the teeth of pre-school children in the dental practice is one component of Scotland’s child oral health improvement programme (Childsmile). Nevertheless, evidence shows that application rates of FVA are variable and below optimal levels. The reasons are complex, with...

Background Obesity and dental caries are global public health problems which can impact in childhood and throughout the life course. In simple terms, childhood dental caries and body weight are linked via the common risk factor of diet. An association between dental caries and obesity has been described in a number of studies and reviews. However,...

This Guidance, “Alternatives to imprisonment in Europe: increasing understanding and promoting implementation”, is the result of a 2-year work programme called, “Reducing Prison Population: advanced tools of justice in Europe” JUST/2013/JPEN/AG/4489. This programme was launched in March 2014 and coordinated by the Italian “Community of Pope John XX...

‘Alternatives to detention in Europe: promising practices and tools: a training package’ is the result of a 2-year work programme called, ‘Reducing Prison Population: advanced tools of justice in Europe’ JUST/2013/JPEN/AG/4489. This programme was launched in March 2014 and coordinated by the Italian “Community of Pope John XXIII” Association, and d...

Background: Health coaching (HC) is based on 'partnering with clients in a thought-provoking and creative process that inspires them to maximise their personal and professional potential' to adopt healthy lifestyles through 'building awareness and empowerment'. This study's objective is to assess, for the first time to our knowledge, the effective...

Background This is a protocol for a systematic review of the impact of health coaching on changing the health behaviour of offenders. Prisoners are more likely to suffer from health-related issues when compared to the general population. Health coaching has been shown to influence health outcomes of patients with chronic conditions. This review, th...

Overview of the protocol for the qualitative element of FiCTION RCT.

Objective: To evaluate the contribution of dental anxiety to social gradients in different oral health outcomes and whether social gradients in oral health persist once dental anxiety is removed from the population examined. Methods: Data from 9035 British adults were analysed. Participants' socioeconomic position (SEP) was measured through educ...

Objective: To determine if the sCMT can be used to identify costs of service provision. Clinical setting: Patients (n=495) attending the Sussex Community NHS Trust Special Care Dental Service for care were assessed using the sCMT. Main measures: sCMT score and costs (staffing, laboratory fees, etc.) besides patient age, whether a new patient a...

La gamma delle iniziative introdotta dal governo scozzese e dalle agenzie partner, nazionali e locali, ha lo scopo di ridurre il ricorso alla detenzione di breve durata, di promuovere una risposta più efficace nei confronti delle cause del crimine e di ridurre la recidiva. Queste iniziative indicano che il governo ed i suoi partner riconoscono che,...

Smile4life is Scotland's national oral health improvement programme for people experiencing homelessness. Following an oral health and psychosocial needs assessment of 853 homeless people across Scotland, the Smile4life intervention was developed and rolled out across all NHS boards. Dental health and health and social care practitioners were invit...

Background: Ten percent of UK adults experience extreme dental anxiety. Effective communication between dentist and patient following the handover of a patient completed Modified Dental Anxiety Scale (MDAS) has been hypothesised to reduce dental trait anxiety. The study aimed to examine the effective communication upon dental trait anxiety at 3 mon...

Aim To conduct an exploratory investigation of public dental service (PDS) practitioners' planned sedation modality using a structural equation modelling approach, in order to identify the explanatory value of using the Index of Sedation Need (IOSN), or its component parts, to predict sedation modality in patients referred with dental anxiety. Meth...

Objective To use a model of health learning to examine the role of health-learning capacity and the effect of a school-based oral health education intervention (Winning Smiles) on the health outcome, child oral health–related quality of life (COHRQoL). Setting Primary schools, high social deprivation, Ireland/Northern Ireland. Design Cluster rand...

To explore qualitatively, using a grounded theory approach, homeless people's awareness of their oral health needs and how they access dental services using a deconstruction-reconstruction formulation, and provide recommendations for service designers and dental professionals who work with people experiencing homelessness. A qualitative study using...

Health literacy has been conceptualised to explain how health information facilitates the maintenance of health. What are the clinical implications of children's health literacy? Children have language skills, numeracy, and reading skills that are in a state of flux - how do they decipher and encode adult health messages to make them their own? To...

Poster presenting the research on the impact of engagement between students and marginalised groups in communication skills teaching at University of Dundee

Purpose: To examine dentists’ views of a novel video review technique to improve communication skills in complex clinical situations. Materials and Methods: Dentists (n = 3) participated in a video review known as Video Interaction Guidance to encourage more attuned interactions with their patients (n = 4). Part of this process is to identify wher...

Data sourcesPubMed, Embase, PsycoInfo, Scielo, Scopus, Web of Science, BBO, Lilacs and York databases supplemented by Google scholar.Study selectionQualitative studies with findings derived from individual or group interviews and structured questionnaires reporting factors that drove dentists towards or away from incorporating caries preventive mea...

Objective To use the Theory of Diffusion of Innovations as a framework to explore the qualitative data gleaned from a process evaluation of the Smile4life intervention across Scottish National Health Service (NHS) Boards and to inform future oral health promotion and homelessness. Design A qualitative exploration. Setting In 2012, the Smile4life...

Aim: To explore the association between school bullying and traumatic dental injuries (TDI) among 15-16-year-old school children from East London. Design: Data from phase III of the Research with East London Adolescents Community Health Survey (RELACHS), a school-based prospective study of a representative sample of adolescents, were analysed. A...

Objective: To assess the use of the WCMT in two Scottish health boards and to consider the impact of simplifying the tool to improve efficient use. Design: A retrospective analysis of routine WCMT data (47,276 cases). Clinical setting: Public Dental Service (PDS) within NHS Lothian and Highland. Method: The WCMT consists of six criteria. Each crite...

Data sourcesMedline, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), LILACS (Latin American and Caribbean Health Sciences), CNKI (China National Knowledge Infrastructure), Wanfang (China) and the South African Department of Health databases were searched. In addition the archives at the WHO Collaborating Centre for Nutrition a...

To assess self-reported dental anxiety (DA) among Kuwaiti adolescents and to test whether different dental anxiety scales are valid for measuring DA in Kuwait. Cross-sectional, structured, anonymous questionnaire survey in Arabic completed at government schools. 757 pupils aged 13-15 years from three schools filled the questionnaire. Useable respon...

This article is about dental caries and body weight. It will provide the reader with an overview of the complexity in the relationship between these and suggest the implications of taking a public health approach when addressing them within a primary dental care setting. Clinical Relevance: To provide dental care professionals with an update on the...

Background In 2003 the Scottish Government led the way in school food reform in the UK through their Hungry for Success policy document. This led to nutrient standards being formalised through legislation and monitoring. More recently a new curriculum has been introduced to enhance food education within schools. It stresses practical food skills...

A theory-led narrative approach was used to unpack the complexities of the factors that enable successful client adherence following one-to-one health interventions. Understanding this could prepare the provider to anticipate different adherence behaviours by clients, allowing them to tailor their interventions to increase the likelihood of adheren...

To investigate the role of geography (place of residence) as a moderator in the relationship between dental caries disease and treatment experience and dental fear in 16-year-olds living in Malaysia. A multi-stage-stratified sampling method was employed. Five hundred and three, 16-year-olds from 6 government secondary schools participated in this s...

Objective: The aim of this review was to explore the peer-reviewed literature to answer the question: 'Why are people afraid of the dentist?' Method: Relevant literature was identified by searching the following on-line databases: PubMed, PsycInfo, the Cochrane Library and Google Scholar. Publications were extracted if they explored the causes a...

To test a theoretical model based on Cohen's dental profession factors (training; practitioner attitudes; geography) to investigate practitioners' willingness to treat adolescents with learning disabilities (LD) in primary dental care. A sample of all 537 primary care dentists working in a mainly urban area of Northern Ireland and a more rural area...

Communication within clinical settings is crucial for successful clinical practice. However, this is challenging when the clinician interacts with patients with Intellectual Disabilities (ID) who may have communication difficulties or find it difficult to understand the treatment process. The "Stories at the Dentist" project aims to develop a suppo...

A recent UK population survey of oral health included questions to assess dental anxiety to provide mean and prevalence estimates of this important psychological construct. A two-stage cluster sample was used for the survey across England, Wales, and Northern Ireland. The survey took place between October-December 2009, and January-April 2010. All...

To examine the use of dental therapist/hygienists to provide primary dental treatment in remote-rural areas with regard to their effectiveness, efficiency, sustainability, acceptability and costs (affordability). The structured literature review of studies indexed in Medline, Embase and CinAHL was conducted using search terms relevant to 'dental th...

Objectives: To assess the validity and reliability of a Parental Dental Concerns Scale (PDCS) to identify parents unable to access preventive dental care for their children. Methods: Two studies were conducted. In Study One, a purposive convenience sample of 399 Scottish parents answered questions on going to the dentist, family life and demogra...

Objectives: To identify the job resource beliefs of preregistration dental nurses and subsequently investigate their relationship with work engagement, personal accomplishment and intention to leave amongst this occupational group in Scotland. Methods: A cross-sectional survey design was used. The Utrecht Work Engagement Scale, Personal accompli...

The Basic Cooking Skills/Healthy Eating (BaCE) programme was first proposed in HMYOI Polmont in 2008 as a collaborative health improvement venture between NHS Forth Valley and the Scottish Prison Service (SPS). The collaboration sought to develop the programme, including its structure, content, delivery, and to use it as a social learning tool, bas...

The importance of understanding barriers to dental attendance of adults in the UK was acknowledged in the first Adult Dental Health Survey in 1968 and has been investigated in all subsequent ADH surveys. In 1968, approximately 40% of dentate adults said they attended for a regular check-up; by 2009 this was 61%. Attendance patterns were associated...

Data sourcesMedline and the Social Science Index Citation databases were searched.Study selectionStudies had to have used measures of dental anxiety completed by children themselves (≤16 years), been published in English and reported primary data. Non-validated measures, those using proxy measures and non-dentally specific measures were excluded.Da...

Most of the Republic of Ireland's public water supplies have been fluoridated since the mid-1960s while Northern Ireland has never been fluoridated, apart from some small short-lived schemes in east Ulster. This study examines dental caries status in 16 year-olds in a part of Ireland straddling fluoridated and non-fluoridated water supply areas and...

Obesity and dental caries have become increasingly prevalent challenges to public health. Research results into the relationship between obesity and dental caries in children have been mixed and inconclusive. The aim of this review and meta-analysis was to provide evidence to quantify the relationship between obesity and dental caries in children u...

Background Early Childhood Caries (ECC) is a widespread problem in Australian Aboriginal communities causing severe pain and sepsis. In addition dental services are difficult to access for many Aboriginal children and trying to obtain care can be stressful for the parents. The control of dental caries has been identified as a key indictor in the re...

The aim of the evaluation was to examine the impact of an Oral Health Improvement Project on the oral health-related knowledge, attitudes and behaviours of prisoners in this high-security gaol. Prisoners in a high-security prison that had adopted a health-promoting prison agenda were invited to take part. Prisoners in locations where the Project ha...

Homeless people are susceptible to a range of health problems, yet in terms of health promotion, tend to be a hard-to-reach, marginalized group. Robust evidence regarding the ability to engage with this population via effective health promotion programmes is essential if policy and practice are to be informed to improve the health of homeless peopl...

Objective: The National survey adult dental health (ADH) is carried out every ten years to assess the health of the adult population. Method: The sample size for the survey was 13,400 households, A total of 11,380 individuals were interviewed, and 6,469 dentate adults were clinical examined. The assessment used to measure dental anxiety was the m...

Objective: Dental anxiety is one of the most important reasons for avoiding dental visits. The aim of the study was to determine the self-reported prevalence of dental anxiety among adolescents in Kuwait. Methods: Structured questionnaires in Arabic were filled in anonymously at schools during regular classes supervised by teachers and researcher...

Objectives To review the evidence of a relationship between sugar-containing methadone and dental caries. Data sources A systematic search of Cochrane Library, PubMed, PsychINFO, EMBASE, MEDLINE, Current Controlled Trials, WHO, OHRN, SIGLE and ERIC databases was conducted from January 1978 up to June 2010. Study selection Articles were assessed a...

To show if cues, concerns and provider responses (defined in VR-CoDES and VR-CoDES-P manuals) are present, can be reliably coded and require additional advice for adoption in a dental context. Thirteen patients in a dental practice setting were videoed with either their dentist or hygienist and dental nurse present in routine treatment sessions. Al...