Evaluation of risk factors for dental caries from 6 to 8 years old children

Important aspects of conducting an interdisciplinary public preventive oral health project for children in areas with low socioeconomic status: staff perspective

Background

To achieve good and equal oral health in children, interdisciplinary preventive oral health actions, directed toward disadvantaged areas, can be an important means. Staff play a crucial role in the implementation of these actions. The aim of the present study was to analyze circumstances of importance for conducting an interdisciplinary public preventive oral health project for children, directed toward parents in areas with low socioeconomic status from the interdisciplinary perspective of the involved staff.

Method

The present study consisted of a qualitative content analysis with an inductive approach, based on interviews with interdisciplinary staff who had participated in a public preventive oral health project directed toward parents in areas with low socioeconomic status. The interviews were analyzed using text-driven analysis.

Results

The main category concerned the staff members’ prerequisites and understanding necessary to perform their tasks in interdisciplinary public preventive oral health project. To have the right prerequisites and understanding regarding the oral health project enabled staff to be committed, able and willing to perform in it. Important aspects of this are to have knowledge, motivation and to experience a supportive professional context, to have good leadership and for certain resources to fulfilled. A crucial aspect was to reach the targeted mothers.

Conclusions

For interdisciplinary cooperation in preventive oral health care to be achieved, it is essential for the involved disciplines and professions to embrace a common view on the project’s aim, their duties, and oral health, from the leadership to the individual level. Staff require competent leadership but also allocated time and adapted method support to be successful in this context. When allocating preventive health actions directed at low SES areas, it is important to acknowledge the risk of stigmatization and for staff to understand that families might be facing social challenges that prevent them from taking part in health-promoting actions. An important conclusion is that to be able to reach people, it is important for both those who design preventive programs for oral health and the staff who administer them to have sufficient knowledge about the target group.

Perception and belief in oral health among Karen ethnic group living along Thai-Myanmar border, Thailand

BACKGROUND

Utilization of oral health services has been low among rural populations in Thailand, especially for minority ethnicity populations living along the borders. The aim of this study was to increase understanding of the determinants of the underutilization of oral health services among these populations.

METHODS

A qualitative study using in-depth interview and semi-structured interview was conducted among participants of Karen ethnicity living in Mae Tan Sub-district, Thasongyang District, Tak Province, Thailand. The interviews focused on exploring the participants' perceptions of oral health problems, oral health and hygiene, and oral health-seeking behaviors. The verbatim-transcribed interviews were analyzed using thematic analysis.

RESULTS

A total of 101 participants (50 adults and 51 children) with a Karen ethnic background took part in the interviews. Most participants could not identify oral health problems and did not perceive dental disease as a problem unless there was severe pain that could not be relieved by painkillers. The Karen ethnic community worked as subsistence farmers, and their busy daily activities consisted of farming, going to the forest to hunt and gather, performing housework, and taking care of their children. Dental health was given a lower priority compared with general health. The perceived value of primary teeth was low, which was identified as an underlying factor resulting in delayed oral health care seeking among this population. The participants had relied on self-care throughout their lifetimes, using either traditional medicines or modern painkillers to relieve toothaches. Fear of dental procedures among children was also described as a barrier to seeking dental health care.

CONCLUSIONS

This study found that the lifestyle and traditions of Karen people living in this area influence their oral health care and hygiene activities as well as their health-seeking behaviors. Further research should emphasize how to improve oral health promotion by providing necessary services and health education appropriately to Karen ethnic populations living along the Thai-Myanmar border.

Dental fear and its determinants in 7-11-year-old children in Tehran, Iran

AIM

To assess dental fear and its determinants in 7-11-year-old children.

METHODS

In this cross-sectional (descriptive-analytical) study, the standard Persian version of the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) questionnaire was completed by 240 parent-child (children aged 7-11 years) pairs referred to dental clinics in Tehran city, Iran. Background characteristics were also inquired.

RESULTS

An equal number of boys and girls participated in the study. The mean score of fear among the children was 21.66 ± 8.33. The causes of fear among the children were, first, injection, and then, seeing the dentist's drill, choking feeling, and finally, filling the tooth. There was a significant correlation between the scores of children's dental fear and their experience of meeting with the dentist (p = 0.001). The result of the regression test showed that the age of the children (p = 0.022) and high levels of dental fear among their fathers (p < 0.001) was related to high levels of dental fear among the children.

CONCLUSIONS

The present children revealed a moderate level of dental fear. Taking children's age into account in behavioural management and challenging father's fear seemed to play a key role to reduce the child's fear and prevent its long-term consequences.

Reasons for reported suspicion of child maltreatment and responses from the child welfare - a cross-sectional study of Norwegian public dental health personnel

BACKGROUND

To prevent child maltreatment, the identification of vulnerable children is essential. In Norway, public dental health personnel (PDHP) report suspicion of child maltreatment to child welfare services (CWS) at a relatively high rate. However, their reasons for reporting and the response from CWS have not been investigated. The objectives of this study were to (1) explore the reasons that PDHP send reports of concern, (2) examine how CWS responds to PDHP reports, and (3) assess whether different reasons for concern are associated with a given response from CWS.

METHODS

A national cross-sectional study was conducted by an electronic survey distributed to public dental hygienists and dentists in Norway. Descriptive statistics were calculated in terms of mean (SD) distributions and frequency, expressed as % (n). To account for clustering of responses among respondents, binomial generalized estimating equation analysis was used to estimate odds ratios (ORs) and confidence intervals (CIs) of CWS responses across number of reports with different reasons for concern.

RESULTS

Of a total of 1542 questionnaire recipients, 1200 (77.8%) responded to the survey. From 2012 to 2014, 42.5% of the respondents sent 1214 reports to CWS, with a mean number of 2.7 (SD = 2.0) reports per respondent. The PDHP sent the reports due to suspicion of neglect or physical, sexual and/or psychological abuse. Non-attendance at dental appointments and grave caries were reported most frequently. Among the reports, 24.5% resulted in measures being taken by CWS, 20.7% were dropped, and 29.4% lacked information from CWS on the outcome. Reports due to suspicion of sexual abuse, (OR 1.979, 95% CI (1.047-3.742), P = 0.036), grave caries (OR 1.628, 95% CI (1.148-2.309), P = 0.006), and suspicion of neglect (OR 1.649, 95% CI (1.190-2.285), P = 0.003) had the highest association with the implementation of measures.

CONCLUSIONS

PDHP report on several forms of child maltreatment and contributes in detection of victimized children. However, the relatively low number of measures being taken by CWS and the number of reports that lack a response to reporters reveal a need for a closer cooperation between the services, as this would benefit both the children at risk and the services.

Protocol for a feasibility study of a self-help cognitive behavioural therapy resource for the reduction of dental anxiety in young people

Background

Childhood dental anxiety is very common, with 10–20 % of children and young people reporting high levels of dental anxiety. It is distressing and has a negative impact on the quality of life of young people and their parents as well as being associated with poor oral health. Affected individuals may develop a lifelong reliance on general anaesthetic or sedation for necessary dental treatment thus requiring the support of specialist dental services. Children and young people with dental anxiety therefore require additional clinical time and can be costly to treat in the long term. The reduction of dental anxiety through the use of effective psychological techniques is, therefore, of high importance. However, there is a lack of high-quality research investigating the impact of cognitive behavioural therapy (CBT) approaches when applied to young people’s dental anxiety.

Methods/design

The first part of the study will develop a profile of dentally anxious young people using a prospective questionnaire sent to a consecutive sample of 100 young people referred to the Paediatric Dentistry Department, Charles Clifford Dental Hospital, in Sheffield. The second part will involve interviewing a purposive sample of 15–20 dental team members on their perceptions of a CBT self-help resource for dental anxiety, their opinions on whether they might use such a resource with patients, and their willingness to recruit participants to a future randomised controlled trial (RCT) to evaluate the resource. The third part of the study will investigate the most appropriate outcome measures to include in a trial, the acceptability of the resource, and retention and completion rates of treatment with a sample of 60 dentally anxious young people using the CBT resource.

Discussion

This study will provide information on the profile of dentally anxious young people who could potentially be helped by a guided self-help CBT resource. It will gain the perceptions of dental care team members of guided self-help CBT for dental anxiety in young people and their willingness to recruit participants to a trial. Acceptability of the resource to participants and retention and completion rates will also be investigated to inform a future RCT.

Dentin caries risk indicators in 1-year-olds. A two year follow-up study

BACKGROUND

Early childhood caries (ECC) risk factors are suspected to vary between regions with different caries prevalence.

AIM

Identify ECC risk factors for 1-year-olds predicting dentin caries at 3 years of age in a region with low caries prevalence.

DESIGN

Caries risk was assessed by dental hygienist or dental assistant in 779 one-year-olds. The oral mutans streptococci (MS) score was performed from a tooth surface or (in pre-dentate children) from oral mucosa. A parental questionnaire with questions regarding family factors (siblings with or without caries), general health, food habits (night meals, breastfeeding, other beverage than water), oral hygiene habits and emerged teeth were answered by parents of the 1-year-olds. Dentin caries was assessed when the children were 3-year-olds. Simple and multiple logistic regression analyses were used for identification of caries-associated factors.

RESULTS

An increased caries risk was assessed in 4.4% of the 1-year-olds. Dentin caries was found in 2.6% of the 3-year-olds. Caries risk at 1 year was associated with caries at 3 years (OR = 6.5, p = .002). Multiple regression analysis found the variables Beverages other than water (OR = 7.1, p < 0.001), Caries in sibling (OR = 4.8, p = .002), High level of MS (score 2-3) (OR = 3.4, p = .03) and Night meal (OR = 3.0, p = .03) to be associated with caries. The single variables Beverage other than water between meals and Caries in sibling were more reliable than Caries risk assessed performed by dental personnel.

CONCLUSIONS

Behavioural, family and microbial factors are important when assessing caries risk among 1-year-olds in a region with low caries experience.

Experience with suspecting child maltreatment in the Norwegian public dental health services, a national survey

OBJECTIVE

Detecting and responding to child-maltreatment is a serious challenge and public health concern. In Norway, public dental health personnel (PDHP) have a mandatory obligation to report to child welfare services (CWS) if they suspect child-maltreatment. This study aimed to assess PDHP's frequency of reporting and failing to report to CWS and whether the frequencies varied according to personal, organizational and external characteristics.

MATERIAL AND METHODS

An electronic questionnaire was sent to 1542 public dental hygienists and dentists in Norway, 1200 of who responded (77.8%).

RESULTS

The majority 60.0%, reported having sent reports of concern to CWS throughout their career, 32.6% had suspected child-maltreatment but failed to report it in their career and 42.5% had sent reports during the three-year period from 2012 to 2014. The reporting frequency to CWS was influenced by PDHP's personal, organizational and external characteristics, while failure to report was influenced by personal characteristics.

CONCLUSIONS

Compared to international studies, PDHP in Norway sends reports of concern and fails to report to CWS at relatively high rates. PDHP's likelihood of reporting was influenced by age, working experience, number of patients treated, size of the municipality and geographical region, while failure to report to CWS was influenced by working experience.

Child, neglect and oral health

Background

Despite advancements in oral health policies, dental caries still a problem. The lack of parents/caregiver’s care regarding child’s oral health, which characterizes neglect, may lead to a high prevalence of caries. Therefore, the objective of this study was to analyze the relation between dental caries and neglect in five year-old children.

Methods

Quantitative study performed in two different moments. First, the children underwent oral examinations and physical inspection. Then, a semi-structured interview was performed with parents of children with high and low caries rate.

Results

In all, 149 physical inspections and oral exams were performed. The number of decayed, missing and filled teeth – dmf-t was 2.75 (SD 2.83); 16 children had extremely high values (dmf-t ≥7), 85 intermediate values (1 ≤ dmf-t ≥ 6) and 48 extremely low (dmf-t = 0). Nearly all caregivers were female (96.7%; n = 29), mostly mothers (93.3%; n = 28). Associations were found between caries experience and reason of the last consultation (p = 0.011), decayed teeth and child’s oral health perception (p = 0.001). There was a trend towards a significant association between general health and decayed teeth (p = 0.079), general hygiene and caries experience (p = 0.083), and caries experience and number of times the child brushes the teeth (p = 0.086).

Conclusion

There’s a relation between caries experience and children’s oral health perception by caregivers, as well as between caries experience and children’s access to dental care. There is a trend towards association between caries experience and risk factors suggestive of neglect.