Caregivers' oral health knowledge, attitude and behavior toward their children with disabilities

Access to oral health care services for children with disabilities: a mixed methods systematic review

BACKGROUND

Children with disabilities experience poorer oral health and frequently have complex needs. The accessibility of oral health care services for children with disabilities is crucial for promoting oral health and overall well-being. This study aimed to systematically review the literature to identify the barriers and facilitators to oral health care services for children with disabilities, and to propose priority research areas for the planning and provision of dental services to meet their needs.

METHODS

This was a mixed methods systematic review. Multiple databases searched included MEDLINE, Scopus, PsycINFO, EMBASE, and CINAHL. The search strategy included Medical Subject Heading (MeSH) terms related to children, disabilities, and access to oral health. Eligibility criteria focused on studies about children with disabilities, discussing the accessibility of oral health care.

RESULTS

Using Levesque's framework for access identified barriers such as professional unwillingness, fear of the dentist, cost of treatment, and inadequate dental facilities. Facilitators of access offered insight into strategies for improving access to oral health care for children with disabilities.

CONCLUSION

There is a positive benefit to using Levesque's framework of access or other established frameworks to carry out research on oral healthcare access, or implementations of dental public health interventions in order to identify gaps, enhance awareness and promote better oral health practices. The evidence suggests that including people with disabilities in co-developing service provision improves accessibility, alongside using tailored approaches and interventions which promote understanding of the importance of dental care and increases awareness for professionals, caregivers and children with disabilities.

TRIAL REGISTRATION

Protocol has been registered online on the PROSPERO database with an ID CRD42023433172 on June 9, 2023.

To assess the knowledge, attitudes, and confidence of caregivers and administrators towards the oral health of nursing home residents in San Antonio, Texas

OBJECTIVE

The primary objective of this research was to use qualitative methods to assess the knowledge, attitudes, and confidence of caregivers in their ability to provide oral hygiene assistance to residents. The secondary objective was to assess the knowledge and attitude of administrators on the provision of oral hygiene assistance for residents, and their confidence in caregivers' ability to provide oral hygiene assistance to nursing home residents in San Antonio, Texas.

METHODS

A semi-structured interview guide was used to conduct face-to-face interviews with seven caregivers and twelve administrative staff from ten nursing homes in San Antonio, Texas. Employees in nursing homes who are caring for residents are referred to as caregivers and those whom they care for are referred to as nursing home residents. One survey instrument was developed for the caregiver's knowledge, attitude, and confidence toward providing oral health care, and another to assess the administrator's knowledge, attitude, and confidence in caregivers providing oral care for nursing home residents. The interviews were recorded, transcribed, and coded for thematic content.

RESULTS

The findings revealed that caregivers and administrators had adequate knowledge of the connection between oral and systemic health. The administrators were confident that caregivers were adequately trained to provide oral hygiene care for residents. Caregivers had a positive attitude toward the importance of good oral health. They regularly assessed the residents' oral health, but due to time constraints, staffing shortages, and other competing tasks providing oral health care to the residents was challenging. Most caregivers were confident in their skills in providing oral care for the residents since 85.6% agreed. On the contrary, almost half of the administrators were confident that caregivers have the necessary skills to provide oral care for residents, while 41.7% were unsure.

CONCLUSIONS

The study gave a broader insight into the provision of oral care in nursing home residents from the perspectives of caregivers and administrative staff. Administrators must provide caregivers with adequate training and time so they can provide adequate oral health care for the residents.

Comparative Assessment of the Efficacy of the GumChucks Flossing System and String Floss for Plaque Removal in Mentally Disabled Children: A Randomized Clinical Trial

Background

Mentally disabled children have been found to have poor oral hygiene, a greater prevalence of periodontal disease, and higher caries prevalence. Flossing is an important oral hygiene skill adjacent to toothbrushing in plaque removal than brushing alone in children. GumChucks is a novel flossing device designed to assist children with easy and proper flossing techniques. To compare the efficacy of the GumChucks flossing system and string floss (SF) for plaque removal in mentally disabled children.

Materials and methods

Participants were randomly assigned to either GumChucks or SF. At baseline, a toothbrushing and flossing demonstration was given to all the participants. Gingival index (GI) and plaque index (PI) were recorded at baseline, 1 week, and 4 weeks postusage.

Results

Overall, there was a significant reduction in GI and PI after first use with children using GumChucks compared to SF floss. After 1 week and 4 weeks of postusage, children in the GumChucks group demonstrated significantly greater improvement in GI (1.03 ± 0.60), (1.12 ± 0.66), and PI (0.97 ± 0.53), (1.10 ± 0.54) from baseline p ≤ 0.05.

Conclusion

GumChucks was an effective alternative plaque removal, with recommended caretakers' supervision for mentally disabled children.

How to cite this article

Takle TV, Vishwakarma PY, Dodamani AS, et al. Comparative Assessment of the Efficacy of the GumChucks Flossing System and String Floss for Plaque Removal in Mentally Disabled Children: A Randomized Clinical Trial. Int J Clin Pediatr Dent 2024;17(3):255-259.

A Cross-sectional Study on the Effectiveness of Two Different Tooth-brushing Exercise Methods in Blind Childrendren

OBJECTIVE

 Blind children tend to have poor oral health. Oral health education is needed to reduce the prevalence of dental caries and periodontal diseases among blind children. The aim of this study was to evaluate the effectiveness of two tooth brushing exercise methods toward blind children's knowledge, attitude, behavior, and oral hygiene.

MATERIALS AND METHODS

 The purposive sampling technique was used in this study on 80 blind children aged between 7 and 16. Children were divided into two groups of 40 children each. In group I, children received the tooth-brushing exercise through the Braille-verbal method, and group II received the tactile-verbal method. Their knowledge, behavior, and attitude were recorded by a questionnaire, and their oral hygiene was assessed during a personal oral examination. Data were analyzed using Wilcoxon-Mann-Whitney non-parametric test.

RESULTS

 Differences in effectiveness toward knowledge, attitude, and oral hygiene were found between both methods with the following values: p-value = 0.04 (<0.05), 0.04 (<0.05), and 0.0002 (<0.05). No difference in effectiveness toward behavior was found: p-value 0.30 (>0.05).

CONCLUSION

 The two tooth-brushing methods could change knowledge, attitude, and oral hygiene in blind children. The tactile-verbal method was more effective than the Braille-verbal method in changing blind children's oral hygiene.

A mixed methods evaluation of the effectiveness of an oral health training program for disability care workers in Burkina Faso

BACKGROUND

While efforts to improve the oral health of vulnerable populations have received little attention in general, the situation of children with disabilities in low- income countries (LICs) remains especially challenging. The present study evaluated the effectiveness of an oral health training provided to disability care workers in Ouagadougou, Burkina Faso thereby contributing to closing the knowledge gap in disability research in relation to oral health in LICs.

METHODS

This was a single-arm pre-post study following an embedded mixed methods design using the New World Kirkpatrick training effectiveness evaluation model. For the purposes of this study, three levels of the Kirkpatrick (KP) evaluation were considered: reaction, learning and behaviour.

RESULTS

A total of 44 care workers from 6 disability centres participated in the study. Care worker post-training scores (Md = 17) were significantly higher compared to pre-training scores (Md = 13) [Wilcoxon signed-ranks test: Z= -5.53, p < .001, r = .59.] The median value for care worker confidence in applying training material in their everyday job was 7 out of 10 points (IQR = 3). At the 1-month training follow-up, 3 centres had implemented daily toothbrushing for people with disabilities.

CONCLUSION

These findings suggest that tailored training led to an increase in care worker confidence and motivation to implement oral health activities, in knowledge about oral health and a partial implementation uptake of daily toothbrushing in disability centres. Further long-term evaluations with dental care provision in rural and urban settings are needed to lower the high oral disease burden of people with disabilities in Burkina Faso.

Socio-behavioural determinants associated with the first dental visit in Saudi children: A cross-sectional study

BACKGROUD

Oral health is an integral component of overall well-being, understanding the age at which children have their first dental visit (FDV) and the socio-behavioural factors influencing these visits is essential for improving oral health outcomes in children.

AIM

This study aimed to determine the age at which Saudi children had their FDV and the socio-behavioural predictors associated with these visits in Al Jouf Province, Kingdom of Saudi Arabia.

DESIGN

This cross-sectional study used a multistage stratified random sampling technique to invite 566 parents/guardians of schoolchildren aged 12 years or younger. Multinomial logistic regression analysis was used to identify socio-behavioural variables that predict children's FDV. p < 0.05 was considered statistically significant.

RESULTS

Most FDVs in children occurred between the ages of 6 and 10 years. More than half of the participants stated that FDVs occurred primarily because of dental pain. Furthermore, educated mothers reported a higher frequency of dental visits for their children. Children with a low family income were 63% (95% confidence interval 0.16-0.83; p = .015) less likely to visit a dentist between the ages of 1 and 5 years.

CONCLUSION

First dental visits in children in Al Jouf Province typically occurred between the ages of 6 and 10 years, with dental pain being the main reason. Parents' or caregiver's relationships with children, parental age and familial income were identified as predictors of the FDV.

A descriptive study on oral hygiene practice and caries increment in children with growth stunting

Introduction

Stunting is a condition of malnutrition in children from the womb to the early life stage that causes growth failure in the body and brain. Stunting influences the development and integrity of the oral cavity and increases the risk of developing diseases in the oral cavity, such as dental caries. The growth barriers in stunting children and parental knowledge can affect maintaining oral hygiene. This study aims to determine the description of oral hygiene practice and caries increment in children with growth stunting.

Methods

This type of research is a quantitative descriptive with a Secondary Data Analysis approach in the form of examination results for the presence or absence of caries through the ICDAS index and the results of the oral hygiene practice questionnaire on 113 children with growth stunting in Sukajadi district, Bandung.

Results

Most stunting children (60.2%) experienced increased caries rates classified as low, and 70.8% had poor oral hygiene practices. There were 50 children (44.3%) with poor oral hygiene practice with low caries increment, while 18 children (15.9%) had good oral hygiene practice with low caries increment.

Conclusion

Oral hygiene practice is classified as poor, but caries increment is still relatively low in most stunting children in Sukajadi district, Bandung.

Analysis of Oral Health Literacy in Caregivers of Special Needs Individuals in Special Schools and Social Institutions in Jakarta

BACKGROUND

Individuals with special needs (IWSN) are susceptible to oral conditions such as caries and periodontal disease. In order to improve oral health of IWSN, it is important to improve the oral health literacy (OHL) of caregivers, as they play an important role in the daily hygiene and personal care of these people.

OBJECTIVE

This study aimed to analyze the OHL in caregivers of IWSN in special schools (informal caregivers) and social institutions for people with disabilities (professional caregivers) in Jakarta, Indonesia.

METHODS

The study was conducted with a cross-sectional and descriptive analytic design with a cluster sampling method of 400 informal and professional caregivers. The study utilized the validated Health Literacy Dentistry-Indonesian Version (HeLD-ID) questionnaire to measure OHL. Quantitative data was analyzed using non-parametric Kruskal Wallis and Mann Whitney tests (significant level p < 0.05).

RESULTS

The median total OHL score of respondents was 3.14 (0.24-4) for informal caregivers and 3.21 (0-4) for professional caregivers. The OHL score of the two populations showed significant differences in the domains of receptivity (p = 0.036), understanding (p = 0.030), and economic barriers (p = 0.022). Significant differences in OHL scores were also noted among caregivers according to their sociodemographic characteristics, such as level of education, and number of IWSN handled.

CONCLUSION

Informal and professional caregivers in this study showed good level of OHL. To elucidate the relationship between caregiver's level of OHL with IWSN, further study is necessary.

Caregivers’ knowledge, attitudes, and oral health practices at long-term care facilities in KwaZulu-Natal

Background

Vulnerable individuals residing at long-term care facilities require special oral health consideration. Examining concepts of oral health and hygiene practices of caregivers becomes essential for understanding the quality of oral health services provided to residents.

Aim

This study explored the oral health-related knowledge, attitudes and practices (KAP) of caregivers.

Setting

Long-term care facilities in the eThekwini District, KwaZulu-Natal.

Methods

A cross-sectional study was conducted at seven long-term care facilities among 188 caregivers who completed a self-administered questionnaire. Data were collated and analysed using the Statistical Package for the Social Sciences (SPSS) version 24. Inferential techniques included an analysis of variance (ANOVA) test. A p-value ≤ 0.05 was considered to be statistically significant.

Results

Participants reported that dentures do not to be cleaned (n = 139; 73.9%). Participants (n = 70; 37.2%) reported that some medications have oral side effects. Most participants (n = 173; 92%) were optimistic about improving their oral health knowledge and skills. Participants (n = 108; 57.4%) only reported flossing when they had food trapped between their teeth. Few participants (n = 30; 16%) reported visiting the dentist every 6 months.

Conclusion

Participants had a positive attitude to improve their oral health-related knowledge and practices. However, the study showed that there is a need to scale-up oral health education and training activities for caregivers.

Contribution

It is envisaged that findings of this study will demonstrate the importance of oral health-related knowledge among caregivers in providing better oral health care through improved attitudes and practices.

Caregivers’ Perception about the Relationship between Oral Health and Overall Health in Individuals with Disability in Qatif, Saudi Arabia: A Cross-Sectional Study

Background

In Saudi Arabia, there are many people with disabilities that do not receive adequate healthcare, especially in the field of dentistry.

Objective

This study focused on assessing caregivers' perception of the relationship between oral healthcare and the overall health status of individuals with special healthcare needs (SHCN) in Qatif, Saudi Arabia. Methodology Design. This cross-sectional study was conducted using a questionnaire that was divided into two sections. The first part included demographic information such as the age and gender of both the caregiver and the person with a disability and the type of disability. The second part investigated the systemic health of the individual with a disability and the caregivers' perception of the relationship between the management and treatment of systemic health and oral healthcare in relation to the overall health status. The results of descriptive analyses were summarized using frequency distribution tables. Bivariate analyses (chi-square test) were also performed. Significant differences were considered at a p value of 0.05. Setting. Initiated in school setting.

Results

A total of 186 caregivers participated in the study. As much as 83.3% agree that oral health affects overall health, and 48.9% agreed that untreated dental problems could affect cardiac health. Age was the only factor found to be significantly associated with caregiver perception as younger caregivers were more likely to rightly understand the relationship between oral health and general health (p < 0.05).

Conclusion

This study has shown the extent to which caregivers of individuals with special care needs to understand the role of oral health in the general health of an individual. Three-quarters of the caregivers agree that dental health affects overall health, and age is a factor that might influence this understanding.

Salivary and Dental Plaque Composition in Disabled Children Who Require Home Care: A Cross-sectional Investigation

Aims

The purpose of this study was to compare salivary and dental plaque (DP) composition between disabled children who require home care (DCHC) and a control group (CG) and to correlate it with oral and systemic health factors.

Materials and Methods

This cross-sectional study included 15 DCHC and 15 healthy children (aged between 4 and 10 years). The caregivers answered a questionnaire on disease diagnosis, medical history, dental history, and oral hygiene routine. In addition to clinical examination, saliva and DP samples were collected and analyzed using attenuated total reflection-Fourier transform infrared spectroscopy. Data were collected between January and December 2019. Student's t and Kendall correlation tests were used.

Results

Calculus (46.7%), bleeding on toothbrushing (53.3%), and gingival hyperplasia (40.0%) were prevalent in DCHC. The saliva of DCHC presented a higher amount of lipids and collagen and a lower amount of carbohydrates than that of the CG (P < 0.05). DP components were similar in DCHC and CG.

Conclusion

DCHC presented oral comorbidities and changes in salivary composition, compared with the CG.

Oral health knowledge, practice, and oral health status among rohingya refugees in Cox’s Bazar, Bangladesh: A cross-sectional study

Oral health is a critical component of human health but is sometimes forgotten, particularly during humanitarian crises. This research aimed to ascertain the state of oral health among Rohingya refugees living in one of the largest refugee camps and evaluate their knowledge and practice of oral health. A multicenter cross-sectional survey was conducted among 477 participants from July to September 2021 using a structured questionnaire. There were 34 Rohingya camps and out of those 14 camps were accessible for data collection. The study participants were between 18–82 years residing in the refugee camps under Cox’s Bazar. The majority of participants (53.88%) were female and between the ages of 25 and 45. Around 46.12% of respondents did not have basic oral health knowledge, while 53.67% were in need of dental care. Nearly half of the participants demonstrated poor oral health practices. Participants’ age and educational level were positively associated with oral health knowledge (p = 0.02 and p<0.001). Furthermore, the knowledge level was positively associated with oral health practice (p = .025). Participants with a history of teeth pain and discomfort in the last 12 months were ten times more likely to seek treatment (OR = 9.93, CI: 5.591–17.64). The study indicated a growing demand for dental care among Rohingya refugees staying in Bangladesh. To reduce the severity of oral health issues, use of minimally invasive restorative procedures can be suggested in camps. New oral health promotion campaigns should be emphasized and proper education, ideally in their original language, can be beneficial.

Relationship between Aspiration Pneumonia and Feeding Care among Home Care Patients with an In-Dwelling Nasogastric Tube in Taiwan: A Preliminary Study

Home care patients have swallowing dysfunction and rely on an in-dwelling nasogastric tube (NGT) to complement oral food intake, supplement their diet, and maintain adequate nutritional status. This study explored the relationship between aspiration pneumonia (AP) and feeding care among home care patients with an in-dwelling NGT. This preliminary study employed a cross-sectional design. There were 35 patients who relied on an in-dwelling NGT to complement their oral intake of food (NGT-oral feeding) and their primary caregivers participated in this study. All of them developed AP in the past year. Factors involving food intake performance during mealtime of the home care patients and feeding care provided by the caregivers were simultaneously observed and recorded. Among the six risk factors univariately correlated with the incidence of AP, feeding in a noisy environment, using a large spoon to feed the participants, more than 5 mL of food per mouthful, food intake duration lasting > 30 min, swallowing twice for each mouthful of food, and coughing at least once every day remained significant in the logistic regression model (all p < 0.05). Four risk factors for AP were correlated with feeding care; the adjusted risk ratio ranged from 6.17 to 14.96 (all p < 0.05). In addition to each individual’s food intake ability, improper feeding assistance was related to the risk factors for AP among home care patients with NGT-oral feeding. Thus, home caregivers should receive safe oral feeding education and training.

Investigating Perceptions of Teachers and School Nurses on Child and Adolescent Oral Health in Los Angeles County

This study reports the results of focus groups with school nurses and teachers from elementary, middle, and high schools to explore their perceptions of child and adolescent oral health. Participants included 14 school nurses and 15 teachers (83% female; 31% Hispanic; 21% White; 21% Asian; 14% African American; and 13% Others). Respondents were recruited from Los Angeles County schools and scheduled by school level for six one-hour focus groups using Zoom. Audio recordings were transcribed, reviewed, and saved with anonymization of speaker identities. NVivo software (QSR International, Melbourne, Australia) was used to facilitate content analysis and identify key themes. The nurses’ rate of “Oral Health Education” comments statistically exceeded that of teachers, while teachers had higher rates for “Parental Involvement” and “Mutual Perception” comments. “Need for Care” was perceived to be more prevalent in immigrants to the United States based on student behaviors and complaints. “Access to Care” was seen as primarily the nurses’ responsibilities. Strong relationships between community clinics and schools were viewed by some as integral to students achieving good oral health. The results suggest dimensions and questions important to item development for oral health surveys of children and parents to address screening, management, program assessment, and policy planning.

Coping strategies of caregivers in performing oral hygiene care in adults with special needs: A qualitative study

INTRODUCTION

Basic and daily oral hygiene care is essential for maintaining oral health in adults with special needs. The caregivers act in this process and need to be understood about the difficulties and the resources they use to deal with this demand. The aim of this qualitative study was to understand the difficulties and strategies of caregivers regarding oral hygiene for adults with special health care needs (SHCN) METHODS: Twenty-one caregivers of adults with SHCN participated in an interview in which the following questions were asked: What are the greatest difficulties in performing oral hygiene for the adult with SHCN you take care? and "How do you overcome these difficulties?" The interviews were recorded and the qualitative data were analyzed using the Discourse of the Collective Subject technique RESULTS: All respondents were female with a mean age of 58.5 years (± 10.8) and the adults with SHCN presented mean age of 30 years (± 18). The greatest difficulty pointed out by caregivers regarding oral hygiene for adults with SHCN was their non-cooperation to do such activity. Regarding coping strategies, caregivers pointed out several strategies to perform oral hygiene in adults with SHCN, such as supervising their brushing, seek for a qualified dentist to assist with this task, performing oral hygiene during the bath, performing physical restraint, among others CONCLUSION: The caregivers' perspectives indicate feelings of failure, discomfort, but also the use of creative resources to deal with the task. The results bring up themes that refer to anxieties and are related to technical and dental issues, that could be explored and need to be recognized by the reference oral healthcare team, whose responsibility it is also to work for the empowerment of caregivers.

Cross-cultural adaptation and psychometric properties of the Indonesian version of theory of planned behavior questionnaire to measure dental attendance of children with hearing loss: A pilot study

AIMS

To translate and evaluate the validity and reliability of the Indonesian version of the Theory of Planned Behavior (TPB) questionnaire concerning mother's behavior related to children's dental attendance.

METHODS AND RESULTS

The cross-cultural adaptation was tested in mothers with children aged 5-12 years old who have hearing loss. The validity and reliability of the online questionnaire were measured among 31 mothers of children with hearing loss in communities and Special School for Children with Hearing Loss in several regions in Indonesia. All indicators of attitude, subjective norms, and perceived behavior control (PBC) on mothers' behavior towards children's attendance was valid (p < .05). The overall Cronbach's alpha of the questionnaire for internal consistency was 0.773. The test-retest reliability results were based on repeated administration in the same participant mother, measured at one-week interval; the interclass correlation coefficient (ICC) was 0.903.

CONCLUSION

The Indonesian version of the TPB questionnaire concerning mother's behavior related to children's oral health has shown adequate validity and reliability for investigating the dental attendance of children with hearing loss.

Impact of parental care on oral health of children with Intellectual Disabilities from zero to six years of age

Abstract Introduction the birth of a child with an intellectual disability requires the definition of the parents' roles in relation to the care of the child. Objective evaluate how much parental care practices, sociodemographic and behavioral characteristics and family knowledge can have an impact on the oral health of children with intellectual disabilities in the age group from zero to six years of age. Material and method the level of help given to the child in the practice of oral hygiene was evaluated according to the adapted functional independence scale. The Parental Beliefs and Care Practices Scale assessed primary care and stimulation offered to the child. The presence of dental plaque and the decay-missing-filled teeth (DMFT) index were analyzed. The significance level was 5%. Result the relative percentage of dental plaque was 11.4%. The DMFT was 2. The prevalence of teeth with indicated extraction is higher in children who receive full assistance for cleaning, when compared to those who receive maximum, moderate help or supervision. Higher levels of dental plaque and decayed teeth were found in children whose parents rated their dental health as poor, hygiene as deficient, and when they believed their children might feel discomfort due to their oral health. Low stimulation frequency resulted in a higher plaque index and number of decayed teeth. Conclusion the frequency of parental care stimulation influenced the percentage of plaque index and the number of decayed teeth in children with intellectual disabilities.

Factors associated with a late visit to dentists by children: A cross-sectional community-based study in Saudi Arabia

Objectives

This cross-sectional study aims to determine children's age at their first visit to dentists and factors associated with these visits.

Methods

This cross-sectional community survey-based study was conducted in 2019 during the events of the 10th Gulf Oral Health Week in Jeddah, Saudi Arabia. All participants including visitors and dentists, with current or previous experience in caring for children aged six months to ten years, provided their consents for the study.

Results

Among the visitors, 348 participated in the survey. Most children, aged three to ten years, first visited the dentist with complaints of pain and dental cavities. The risk of a late visit to the dentist increased (OR: 2.28; CI 95%: 1.01–5.14) among caregivers who did not help their children brush their teeth. Using the Internet for accessing health information negatively impacted the visits (OR: 27.00; CI 95% 1.26–57.35). While employed mothers took their children to the dentist at an earlier age (OR: 2.284; CI 95% 1.08–4.79), early visits were mostly missed by mothers with smaller families (OR: 0.043; CI 95% 0.48–0.98).

Conclusion

The results of our study show that the caregiver's attitude, source of health information, employment, age, and number of children are risk factors associated with late visits to dentists.

Factors associated with dental hospitalisations in children with intellectual disability or autism spectrum disorder: a Western Australian population-based retrospective cohort study

PURPOSE

This study investigated dental hospitalisations in Western Australian (WA) children with intellectual disability (ID) and/or autism spectrum disorder (ASD) aged up to 18 years.

METHODS

Data on WA live births from 1983 to 2004 from the WA Midwives Notification System were linked to the Intellectual Disability Exploring Answers database, the WA Hospital Morbidity Data System, and the Western Australian Birth Defects Registry databases. Children were followed from birth to 2010 and the data grouped into three age-groups. Primary and secondary admissions for relevant dental diagnoses were identified and factors associated with having a dental hospitalisation investigated.

RESULTS

There were 1366, 1596, and 780 dental hospitalisations amongst 1122, 1154, and 609 children with ID and/or ASD in the 0-6, >6-12, and >12-18 year age groups, respectively. Children with severe ID were much more likely to be hospitalised than those with mild/moderate ID. More socioeconomically disadvantaged children were less likely to be hospitalised than children whose parents were socially advantaged.

CONCLUSIONS

There is concern that more vulnerable children in the WA community with ID or ASD are receiving an inadequate level of dental services compared with other groups resulting in potentially preventable hospitalisations, a situation in need of urgent remediation.Implications for rehabilitationLittle is known about why some children with intellectual disability (ID) or autism are being hospitalised for their dental care and others are not.Children with disability whose families are socioeconomically disadvantaged should have equivalent opportunity to receive optimal dental care.Dental practitioners at all levels need training and confidence in treating children with ID.

Dental Treatment Needs and Related Risk Factors among School Children with Special Needs in Taiwan

The purpose of this study was to assess dental treatment needs (TNs) and related risk factors of children with disabilities (CD). This cross-sectional study recruited 484 CD, 6 to 12 years of age, from 10 special education schools in Taiwan. Dental status and TNs were examined and evaluated by well-trained dentists and based on the criteria set by the World Health Organization (1997). The results indicated that 61.78% required restorative dental treatment due to their dental caries. On average, each participant had 2.72 teeth that required treatment, and 6.38 surfaces required restoration. One-quarter of the participants (24.79%) required 1- or 2-surface restoration, and one out of three (36.98%) had more complex TNs (including 3 or more surfaces to be filled, pulp care, extraction, and more specialized care). The significant risk factors associated with restorative TNs among CD were those whose parents had lower socioeconomic status, frequent sweets intake, insufficient tooth-brushing ability, and poor oral health. Most of the CD had extensive unmet TNs for their caries and required complex treatment to recover the function of their teeth. Encouraging parents/caregivers to take their children for dental treatment, promoting awareness of the importance of dental hygiene, giving assistance to brushing their teeth after eating, and controlling and/or modifying sweet diet habits are necessary to reduce CD’s dental caries, especially those with lower socioeconomic status parents/caregivers.

Visual pedagogy-guided toothbrushing training to enhance fine motor skills in individuals with intellectual disabilities and impaired fine motor skills

AIMS

To evaluate the effect of visual pedagogy-guided toothbrushing training on oral hygiene, toothbrushing ability, and fine motor skills in individuals with intellectual disability (ID) and impaired fine motor skills.

METHODS

This quasi-experimental study comprised 37 subjects aged 6-24 years. The plaque index (PI), gingival index (GI), toothbrushing ability, and fine motor skills were evaluated before and after 3 and 6 months of individual visual pedagogy-guided toothbrushing training. Friedman's post hoc test and Spearman's correlation coefficient were used for statistical analyses.

RESULTS

The PI, GI, toothbrushing ability, and fine motor skills of the 23 subjects who remained in the study at the 6-month follow-up period significantly improved from those measured at baseline (p < 0.05). A significant association was observed between the improvements in both toothbrushing ability and fine motor skills (p < 0.05).

CONCLUSIONS

Visual pedagogy-guided toothbrushing training could improve the oral hygiene and toothbrushing ability of individuals with ID and impaired fine motor skills. Moreover, improvements in the toothbrushing ability could enhance the fine motor skills of these individuals.

The Impact of Oral-Gut Inflammation in Cerebral Palsy

Background: Oral-gut inflammation has an impact on overall health, placing subjects at risk to acquire chronic conditions and infections. Due to neuromotor disturbances, and medication intake, cerebral palsy (CP) subjects present intestinal constipation, impacting their quality of life (QOL). We aimed to investigate how oral inflammatory levels predicted gut phenotypes and response to therapy.

Methods: A total of 93 subjects aging from 5 to 17 years were included in the study, and assigned into one of the 4 groups: CP with constipation (G1, n = 30), CP without constipation (G2, n = 33), and controls without CP with constipation (G3, n = 07) and without CP and without constipation (G4, n = 23). In addition to characterizing subjects' clinical demographics, medication intake, disease severity levels, salivary cytokine levels [TNF-α, interleukin (IL)-1β, IL-6, IL-8, IL-10], and Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD). Statistical significance was evaluated by Shapiro-Wilks, Student's T-Test, ANOVA, and ANCOVA analysis.

Results: Salivary proinflammatory cytokines were highly correlated with the severe form of gut constipation in G1 (P < 0.001), and out of all cytokines IL-1β levels demonstrated highest correlation with all gut constipation (P < 0.05). A significant relationship was found between the type of medication, in which subjects taking Gamma-Aminobutyric Acid (GABA) and GABA+ (GABA in association with other medication) were more likely to be constipated than the other groups (P < 0.01). Cleary salivary inflammatory levels and gut constipation were correlated, and impacted QOL of CP subjects. G1 presented a lower QOL mean score of CPCHILD (49.0 ± 13.1) compared to G2 (71.5 ± 16.7), when compared to G3 (88.9 ± 7.5), and G4 (95.5 ± 5.0) (P < 0.01). We accounted for gingival bleeding as a cofounder of oral inflammation, and here were no differences among groups regarding gender (P = 0.332) and age (P = 0.292).

Conclusions: Collectively, the results suggest that saliva inflammatory levels were linked to gut constipation, and that the clinical impact of medications that controlled gut was reliably monitored via oral cytokine levels, providing reliable and non-invasive information in precision diagnostics.

Factors Associated with Knowledge, Attitudes, and Practices Related to Oral Care Among the Elderly in Hong Kong Community

Background: The oral health of elderly populations is a significant concern, as it is closely linked to general health and health-related quality of life. Poor oral health exacerbates oral diseases, leading to an increased risk of non-communicable diseases and self-care dependence, particularly in the elderly, worldwide. Knowledge, attitudes, and practices (KAP) play influential roles in individual oral care. However, the evidence of KAP related to oral care among the elderly is still inadequate. Objective: This study aimed to examine KAP and their associated factors related to oral care among the elderly community. Methods: A cross-sectional descriptive design was used. The eligible subjects were recruited, using convenience sampling and snowball sampling. Results: A total of 385 elderly individuals were included, and 51.4% were women. The mean age was 71.66 (SD 6.28). Knowledge was reportedly poor, as more than 50% elderly answered several questions incorrectly. The mean attitude and practices scores were 44.94 (SD 6.33) and 68.90 (SD 10.44), respectively. There was a significant correlation among knowledge, attitudes, and practices (p < 0.001). Multivariable regression analysis revealed numerous factors had remarkably significant association with knowledge [R² = 0.30, F (4,380) = 11.96, p < 0.001], attitudes [R² = 0.28, F (6,378) = 9.27, p < 0.001], and practices [R² = 0.31, F (5,379) = 12.34, p < 0.001], particularly education levels, full-time employment, and self-care independence. Conclusions: Based on the KAP theoretical model, KAP are closely interrelated. Identified factors associated with KAP are useful to understand at-risk groups. Elderly individuals at lower education levels, with poor family support and inadequate self-care independence, have poor KAP related to oral care. Therefore, this study improves insight for health promotion developers, suggesting that more attention should be paid to at-risk elderly groups’ oral health. To enhance participation in dental care and improve oral care performance in the elderly, educational program containing oral health knowledge should be offered to at-risk groups. Family support and involvement are also important for improving oral care among elderly individuals.

The Knowledge, Attitude and Practices of the Caregivers about Oral Health Care, at Centers for Intellectually Disabled, in Southern Region of Saudi Arabia

Oral health is perhaps the most neglected aspect of healthcare for persons living in rehabilitation centers, compared to the general population. The caregivers play a vital role in administering daily oral care to residents in rehabilitation centers: The aim of the present questionnaire-based study was to evaluate the caregivers’ knowledge, attitude and practices towards oral healthcare at centers for the intellectually disabled in the Southern region of Saudi Arabia (SA). The present study was designed as a cross-sectional one-point time survey. The samples were selected by using a non-probability convenience sampling method. The self-administered closed-ended questionnaire comprised of 22 items divided into four sections, which was designed to elicit the demographic information, awareness of oral care, attitude towards oral health and practice of the oral healthcare regime among the participants. Of the164 participants, 53.0% and 47.0% were male and female, respectively. Most of the participants—54.9%—were between 30–39 years of age. Participants were almost equally distributed between educational groups, and about 87% had more than 2 years of experience. A brief overview showed a fair level of knowledge and attitude among 61.6% and 58.5% of respondents, respectively. Participants with an education level above that of high school showed good knowledge and attitude scores (p < 0.05), whereas females showed better attitude scores compared to the males (p < 0.05). Respondents mentioned the difficulties they faced while treating the subjects. The special healthcare workers generally had acceptable oral health knowledge and practices. Caregivers who had lower education levels should be advised for training programs that addressed the importance of oral health services.

Efficacy, tolerability, and safety of an innovative medical device for improving oral accessibility during oral examination in special-needs patients: A multicentric clinical trial

Background

People with special needs have high unmet oral healthcare needs, partly because dentists find it difficult to access their oral cavity. The Oral Accessibility Spatula aims to improve oral accessibility. This prospective multicenter interventional open-label non-randomized patient-self-controlled trial assessed the ability of the spatula to improve the oral accessibility of special-needs patients during dental examinations.

Methods

The cohort was a convenience sample of minor and adult patients with special needs due to physical, intellectual, and/or behavioral disorders who underwent dental check-up/treatment in five French tertiary hospitals/private clinics in 2016–2018 and evinced some (Venham-Score = 2–4) but not complete (Venham-Score = 5) resistance to oral examination. After inclusion, patients underwent oral examination without the spatula and then immediately thereafter oral examination with the spatula. Primary outcome was Oral Accessibility Score (0–12 points; higher scores indicate visualization and probing of the tooth sectors). Secondary outcomes were patient toleration (change in Venham-Score relative to first examination), safety, and Examiner Satisfaction Score (0–10; low scores indicate unsatisfactory examination).

Results

The 201 patients were mostly non-elderly adults (18–64 years, 65%) but also included children (21%), adolescents (11%), and aged patients (3%). One-quarter, half, and one-quarter had Venham-Score = 2, 3, and 4 at inclusion, respectively. The spatula significantly improved Oral Accessibility Score (4.8 to 10.8), Venham-Score (3.1 to 2.6), and Examiner Satisfaction Score (3.4 to 7.2) (all p<0.001). There were no severe spatula-related adverse events.

Conclusion

The spatula significantly improved oral access, was safe and well-tolerated by the patients, and markedly improved oral examination quality.

Quality of life and burden of caregivers of children and adolescents with disabilities

AIMS

To evaluate the quality of life (QoL) and burden of primary caregivers of children and young adults (PCCYAs) with and without disabilities.

METHODS

A cross-sectional study was carried out with sample composed of 336 PCCYAs with cerebral palsy (CP; n = 84), Down syndrome (DS; n = 84), autism spectrum disorder (ASD; n = 84), and without disabilities (control group: CG n = 84), matched by gender and age. The burden of caregivers was assessed with the Zarit Burden Interview (ZBI), whereas QoL was assessed using the WHOQOL-BREF instrument.

RESULTS

QoL and burden of CG presented better results compared to groups with disabilities, with the lowest environmental domain of all study groups (P <.001). The prevalence of burden was moderate for PCCAs of groups with disabilities. There was association between all WHOQOL-BREF and ZBI domains and variables age, schooling, occupation and per capita income (Spearman's correlation coefficient, P <.05). There is a negative impact on WHOQOL-BREF, with an increase in the level of burden of PCCAs with disabilities.

CONCLUSION

The majority of PCCYAs were unemployed married mothers, with low schooling and health problems. Older caregivers experience even higher burden and greater impact on QoL.