Influence of dental care on children's oral health and wellbeing

Effectiveness of various methods of educating children and adolescents for the maintenance of oral health: A systematic review of randomized controlled trials

BACKGROUND

School-based oral health education has emerged as one of the most effective methods to instill a positive attitude toward oral health in children.

AIM

This systematic review (SR) aimed to assess the effectiveness of different methods of oral health education in children and adolescents.

DESIGN

Systematic search was conducted in PubMed, Cochrane, Web of Science, LILACS, Scopus, and EMBASE on January 29, 2023. Review included only randomized controlled trials (RCTs), and their risk of bias (ROB) was assessed by Cochrane RoB-2. Data were extracted and analyzed by expert group. The GRADE approach was used to assess the quality of evidence for each outcome. Every step was conducted in duplicate, and disagreements were resolved by consulting the third reviewer.

RESULTS

The SR included 10 RCTs with majority showing a high ROB. They included 12 methods with the commonest being the use of leaflets/flash cards. Most interventions were effective in improving oral hygiene, gingival health, and knowledge except conventional teaching methods, lecture by using PowerPoint by dentists, and e-learning interventions. The grade of evidence in the majority of outcomes was found to be low or very low.

CONCLUSION

Interventions using the interactive methods such as games, motivational-experiential learning, and audiovisual methods were found to be more effective than controls and other interventions. Variabilities in study methods and outcome variables must be addressed in the future.

Oral health status of 916 children in Tibetan settlement (Bylakuppe, India): A cross-sectional descriptive study

BACKGROUND

Dietary and oral hygiene habits among integrated migrant cultural minorities can vary and could impact susceptibility to caries.

AIM

This study aimed to assess and compare the oral health status of Tibetan schoolchildren living in the Tibetan settlement of Bylakuppe, India, stratified by type of residence.

DESIGN

A descriptive cross-sectional study was conducted among Tibetan schoolchildren attending nine schools in the Bylakuppe region.

RESULTS

The study population consisted of 916 children aged 5-17: 702 (76.6%) living in secular houses (LSH) and 214 (23.4%) living in monasteries (LM). The prevalence of dental caries was 70.9%, and the mean value of decayed, missing, filled teeth for mixed and primary dentition (DMFT*; dmft) of LSH children (1.56 ± 2.34/1.74 ± 2.66) was higher than of LM ones (1.14 ± 2.34/0.83 ± 2.80; p < .001). DMFT for LM children (1.46 ± 2.04) was slightly higher than for LSH children (1.38 ± 1.96; p > .05). Among the sample, 99.1% had a good simplified Oral Hygiene Index (OHI) and LM children showed higher rates of good values (99.5% vs. 98.2% in LSH children). Most children needed preventive/routine dental treatment, whereas 16.6% needed urgent dental treatment. In 4.5% of children, oral mucosal lesions were present.

CONCLUSION

This study confirms the high need for dental treatment in the children of the Tibetan settlement investigated.

Assessment of Pediatricians' and General Practitioners' Knowledge and Practice Regarding Oral Health, Dental Caries and Its Prevention in Children: A Cross-Sectional Study

OBJECTIVES

This study aimed to evaluate and compare the knowledge and practices of family physicians (general practitioners) and pediatricians concerning children's oral health.

MATERIALS AND METHODS

This research involved a cross-sectional survey with 446 respondents, consisting of 77.8% women and 22.1% men, with 81.6% being general (family) practitioners and 18.4% pediatricians. The survey comprised five sections, gathering information on participants' sociodemographic characteristics, routine oral cavity examination in clinical practice, knowledge about dental caries and its prevention, teething symptoms, and alternatives to fluorides for preventing dental caries.

RESULTS

The findings revealed an overall poor understanding of dental caries and its prevention, with an average score of 5.1 ± 1.6 out of a possible 10 points. Notably, practitioners with fewer pediatric patients during the workday, no training on oral health, and uncertainty about physicians' active role in oral health prevention exhibited lower knowledge levels (p ˂ 0.05). Over 90% of participants conducted dental and oral mucosal examinations on their patients. About 25% had received continuing education on children's oral health, and 70.6% expressed interest in further education on the subject.

CONCLUSIONS

This study highlights insufficient knowledge among physicians regarding dental caries and its prevention. With most participants eager to learn and actively promote children's oral health, providing training is essential to boost their knowledge and support children's oral health.

The Participation of Pediatric Dentists in Oral Health Promotion and Education in Serbia

Objectives

To identify the involvement of Serbian paediatric dentists in oral health promotion and education, and to propose further actions for the improvement of these activities.

Methods

This is an analysis of data collected by a cross-sectional, questionnaire-based survey of 445 dentists involved in the provision of dental health services to children at the primary healthcare level. We explored dentists' involvement in oral health education and promotion and the cooperation with other health professionals at the healthcare centre and the community level as well as their attitudes towards the importance of some factors influencing their work.

Results

Dentists estimate their cooperation with different services with ratings higher than 3 on the scale of 1 to 5. They reported the highest satisfaction in cooperation with paediatric services for preschool and schoolchildren (4.0±1.0). At the community level, they reported excellent cooperation with kindergartens (4.4±0.8), while collaboration with Roma health mediators (3.14±1.34) and nongovernmental organizations (2.5±1.4) received lower ratings. According to the average rating (4.7±0.7), dentists perceive the motivation of patients and/or their guardians for keeping good oral health as the factor with the highest importance for the quality of interventions they provide.

Conclusions

Dentists involved in the provision of dental healthcare for children and adolescents in primary healthcare centres in Serbia participate in different oral healthcare education and promotion activities in the community, and highlight the importance of strengthening cooperation with healthcare and other professionals and services aimed at vulnerable population groups, both within the health sector and nongovernmental organizations.

Association of KLK4 rs2235091 polymorphism with susceptibility to dental caries: a systematic review and meta-analysis

Objective

To investigate the association between Kallikrein-related peptidase-4 (KLK4) rs2235091 polymorphism and susceptibility to dental caries (DC) by a method of systematic review and meta-analysis.

Methods

Four English databases were searched for studies on the correlation between KLK4 rs2235091 polymorphism and susceptibility to DC from inception to April 1, 2023. Data analysis was processed by Stata 15.0 software.

Results

Four articles were eligible, including 848 individuals with caries and 463 controls. The results of pooled analysis showed no significant differences in the five gene models (G vs. A: odds ratio (OR) = 1.14, 95% CI: 0.73-1.79, P = 0.567; GG + GA vs. AA: OR = 1.01, 95% CI: 0.77-1.32, P = 0.489; GG vs. GA + AA: OR = 0.84, 95% CI: 0.57-1.23, P = 0.368; GA vs. AA: OR = 1.06, 95% CI: 0.80-1.41, P = 0.681; GG vs. AA: OR = 1.15, 95% CI: 0.57-2.31, P = 0.690). However, subgroup analysis indicated a statistically significant difference in the dominant (GG + GA vs. AA: OR = 1.74, 95% CI: 1.02-2.96, P = 0.042) gene model in primary dentition, but no significance in allelic, recessive, homozygous and heterozygous models. Besides, in permanent dentition, no significant differences were found among the five genetic models (all P > 0.05).

Conclusion

KLK4 rs2235091 polymorphism may be associated with susceptibility to DC of pediatric primary dentition, but not with the risk of caries of permanent dentition. Genotype GG + GA may increase susceptibility to DC of pediatric primary dentition. However, considering the limited records enrolled in this review, more trials with larger sample sizes and more rigorous designs are needed to verify the conclusions of this meta-analysis in the future.

Systematic Review Registration

https://inplasy.com/, identifier INPLASY202380014.

Knowledge, perceptions, and behavior regarding children's oral health among Syrian pediatricians: a cross-sectional study

BACKGROUND

Oral health has a direct impact on health-related quality of life (HRQoL). Hence, general health and oral health cannot be separated. Pediatricians play a pivotal role in providing primary care for infants and are the first to interact with them since birth. Therefore, the aim of this study was to evaluate the knowledge, perceptions, and behavior of Syrian pediatricians regarding children's oral health.

METHODS

This was a cross-sectional study. The questionnaire consisted of six main sections and required answers regarding demographic characteristics, knowledge, behavior, perceptions, and training received in oral health. The association between categorical variables was tested with Pearson's chi-square tests and Fishers exact tests using SPSS ver. 23.

RESULTS

The response rate was 43.12% (229/531). Most of the participants (64.02%) got a poor level of knowledge and no significant association was found between knowledge level and years of experience (p = 0.270). The majority of the participants (99.13%) perceived that diet, bacteria, and sugar exposure time are the etiological factors of dental caries. The overwhelming majority of the participants (98.25%) acknowledged the need for further oral health training during residency.

CONCLUSIONS

Most pediatricians reported a poor level of knowledge. It is recommended to update the postgraduate and residency curriculum to equip pediatricians with adequate knowledge regarding children's oral health.

Early Feeding and Weaning Practices of Indian Children with Early Childhood Caries: A Qualitative Exploration

OBJECTIVE

To describe the early feeding, weaning, and oral hygiene practices of children with early childhood caries (ECC), their parents' knowledge and attitudes regarding infant feeding, and the feeding-related challenges faced by the parents.

METHODS

This descriptive qualitative study involved parents of children with ECC who sought dental treatment at an academic dental college in India. Data were collected though focus groups conducted with the 27 parents of children with ECC, using a focus group discussion guide. Data were analyzed using the content analysis method.

RESULTS

Community norms, such as learning from the older women in the families or neighborhoods, guided the feeding method, duration of feeding, and weaning. Breastfeeding or bottle-feeding at bedtime beyond 12 mo of age and feeding sugary drinks during weaning were standard practices, despite knowing the risk for dental caries. Parents faced multiple challenges regarding weaning and were unaware of the significance of infant oral hygiene practices.

CONCLUSION

In children with ECC, infant feeding practices included prolonged breastfeeding or bottle-feeding beyond the required age, feeding at bedtime, and feeding sugary drinks. Although the parents knew that these feeding habits could increase the risk for caries, they lacked the self-efficacy to translate their knowledge into action during weaning. Also, they lacked awareness regarding infant oral hygiene practices.

KNOWLEDGE TRANSFER STATEMENT

The study provides information on the feeding habits of infants that can increase the risk for caries, the challenges faced by the parents of these children in altering these risky habits, and their lack of knowledge on infant oral hygiene practices. Policy/decision makers can advocate for pediatricians and pediatric dentists to incorporate anticipatory guidance or motivational interviewing techniques to tailor the preventive program for ECC for Indian children.

Health visiting teams and children's oral health: a scoping review

BACKGROUND

Recent policies have recommended early-life interventions to prevent caries. The four nations of the UK each have a national universal children's health programme, through which health visitors and their wider team (HVTs) promote health in the early years. HVT visits offer an opportunity to support parents to improve their child's oral health. A scoping review was conducted to provide a descriptive synthesis of the current literature related to the role of HVTs in improving the oral health of children 0-5 years old and to identify significant gaps for future research. This review informed the feasibility study of the First Dental Steps Intervention, a targeted health visitor-led infant oral health intervention in England.

METHODS

Electronic database searches for peer-reviewed literature were performed using Medline via Ovid and Web of Science (1946-2021). The quality of included intervention studies was assessed using the Effective Public Health Practice Project tool. Additionally, a grey literature search was conducted (key organisations, bibliographic and thesis databases, forwards and backwards citation, Google).

RESULTS

Thirty-nine publications, published between 1980 and 2021, were included. The majority of included papers were from the UK. The quality of intervention studies (n = 7) ranged from weak to strong. Thematic analysis identified the following themes: (1) professional knowledge, education, and training; (2) involvement of HVs in the delivery of oral health interventions; (3) effectiveness of interventions; (4) perspectives of HVs providing oral health advice and acceptability; and (5) barriers and facilitators to promoting oral health. The grey literature search identified 125 sources. HVT involvement was reported in a variety of source types: reports, guidance documents, evaluations, reviews, and training resources. HVTs were involved in oral health by providing oral health packs, brushing and oral health advice, registration and attendance, oral health training, risk assessment, and referral to dental services.

CONCLUSION

The current literature suggests that HVTs are well placed to improve children's oral health. Facilitators and barriers are encountered by HVTs in promoting oral health which should be considered by commissioners. There is a need for future high-quality studies that address the inadequacies found and provide further evidence of the effectiveness of HVT's oral health interventions.

Effect of a Short-Term Intervention with Lactobacillus salivarius Probiotic on Early Childhood Caries-An Open Label Randomized Controlled Trial

ECC is a significant therapeutic and social problem and a global burden on public health. The aim of this clinical trial was to test whether a 2-week daily consumption of chewing tablets containing thermally inactivated L. salivarius reduces the 12-month caries increment compared to the control group. The investigation was a single-center, randomized, controlled open-label, blinded end-point evaluation trial in two parallel groups. At baseline, 140 generally healthy children between 3 and 6 years of age with or without ECC were randomly assigned to the probiotic test group (n = 70) or to the treatment as the usual control group (n = 70). The primary outcome measure was the 1-year increment in caries incidence and prevalence. Secondary endpoints assessed were the initial, cavitated and obvious dentinal caries increment as well as the measurement of dental plaque accumulation, as an indicator of the ECC risk. Data were collected through the clinical assessment of the children's caries (dmft and ICDAS II) and oral hygiene status (DI-S of OHI-S index). Caries incidence and prevalence were statistically significantly lower in the probiotic group versus the control group (p < 0.001 and p = 0.0075). The initial and final mean OHI-S scores in the probiotic group did not show any significant differences. In conclusion, the regular short-term intake of probiotics may reduce caries development. Our findings suggest that self-administered probiotic therapy may provide a good complement to increase the effectiveness of individual preventive home care in preschool children. This is the first clinical study evaluating the effect of a short-term probiotic intervention on reducing early childhood caries with 12 months of follow-up.

Effects of the COVID-19 Pandemic on Children’s Oral Health and Dental Care Use

Background

The COVID-19 pandemic led to early restrictions on access to oral health care and social distancing requirements. The authors examined the early effects of the COVID-19 pandemic on children’s oral health and access to oral health care in the United States.

Methods

Using nationally representative data from the National Survey of Children’s Health, the authors compared several measures of children’s oral health and oral health care use early during the pandemic in 2020 with 1 year earlier. Logistic (multinomial or binary) regression models were estimated, adjusting for several child and household covariates and state fixed effects. Similar comparisons were estimated for 2019 relative to 2018 to evaluate prepandemic trends.

Results

Children in 2020 were 16% (relative risk ratio, 0.84; 95% CI, 0.75 to 0.93) less likely to have excellent dental health as perceived by parents and 75% (relative risk ratio, 1.75; 95% CI, 1.14 to 2.67) more likely to have poor dental health than in 2019. In addition, children in 2020 had higher risk of bleeding gingivae (odds ratio, 1.46; 95% CI, 1.16 to 1.85). The likelihood of having a dental visit in the past 12 months was 27% (odds ratio, 0.73; 95% CI, 0.65 to 0.82) lower in 2020, including lower likelihood for preventive visits. The differences between 2020 and 2019 were observed across demographic and socioeconomic subgroups. There were no such differences between 2019 and 2018.

Conclusions

There was a widespread decline in children’s oral health status and access to oral health care early during the COVID-19 pandemic.

Practical Implications

Prompt policies and oral health campaigns are needed to counter the pandemic effects and increase timely access to dental services.

Early Childhood Caries in 4- to 5-Year-Old Children in Erzurum, Turkey

Introduction: Early childhood caries is tooth decay seen in children under 72 months old. It is associated with multiple predisposing factors and has a negative impact on quality of life. In this study, our aim was to assess the oral health conditions and prevalence of early childhood caries (ECC) in children in the city of Erzurum, Turkey. Materials and Methods: This cross-sectional epidemiological study was conducted in Atatürk University, Faculty of Dentistry, Pediatric Dentistry Department/Erzurum-Turkey, in the 2015-2016 academic year. A total of 1,156 children (588 girls and 568 boys), with mean age of 4.9 ± 0.3 years (min 4, max 5) were included in the study. Restorative index (RI), deft, significant caries index (SiC), SiC10, treatment needs, number of lost primary teeth per 100 children, care index, and prevalence of carious primary teeth were evaluated. Data were analyzed by Chi-square test and Mann-Whitney U test (p < 0.05). Results: A total of 73.3% prevalence of ECC was observed in preschool children with a mean deft score of 3.9±4 and an increase in ECC with age. RI was 2.2%, SiC was 8.5, SiC10 was 12.3, caries treatment needs was 93.5%, care index was 2.1%, and number of lost primary teeth per 100 children was 0.9 tooth. Conclusion: High level of ECC indicates the necessity of starting an oral health education program for mothers and dental screening of children, and the demand for improving oral and dental services.

The Efficacy of Little Lovely Dentist, Dental Song, and Tell-Show-Do Techniques in Alleviating Dental Anxiety in Paediatric Patients: A Clinical Trial

Introduction

Dental anxiety is a common occurrence in patients undergoing dental treatments, especially in children. The success in paedriatric dental treatments and patient comfort depends on controlling the level of patient's anxiety in clinical settings. This study is aimed at evaluating the efficacy of different techniques applied for the reduction of dental anxiety in paediatric patients. Material and Methods. One hundred and sixty participants were divided into 4 groups; each group having 40 patients as follows: group I: mobile application "little lovely dentist," group II: YouTube® "dental video songs," group III "tell-show-do," and group IV "control." Dental prophylaxis treatments were provided to all the participants. Initial anxiety levels were noted during the patient's education phase by measuring heart rate with pulse oximeter and distress level with facial image scale, at the same time in each group, respectively. The postoperative anxiety was noted later with the same methods, after the application of anxiety reduction techniques. The data obtained were entered in the statistical package for the social sciences software, version 25. One-way ANOVA and paired t-test for matched groups were used to compare mean values of the 4 groups, in this study to determine their effectiveness. A p value of ≤0.05 was considered as statistically significant.

Results

The mean age of patients in group 1 was 6.8 ± 2.1 years, group 2: 8.15 ± 2.27 years, group 3: 7.5 ± 2.3 years, and group 4: 7.27 ± 1.68 years. The intragroup comparisons of heart rate and facial image scores have shown a significant difference in before and after dental treatment procedures. Marked reduction in heart rate and facial image scale scores were found in patients belonging to group 1 (mobile applications) and group 2 (dental video songs). An increase in heart rate and facial image scale scores was seen in group 3 (tell-show-do) and the control group.

Conclusion

The paediatric dental anxiety is a common finding in dental clinics. Behavior modification techniques like smartphone applications, "little lovely dentist," and "dental songs" can alleviate dental anxiety experienced by paediatric patients. The "tell-show-do" technique although most commonly used did not prove to be beneficial in the reduction of the anxiety levels.

Ultrastructure and properties of primary carious molars treated using the Hall Technique

BACKGROUND

The Hall Technique (HT) is a method of restoring decayed primary teeth using stainless steel crowns (SSCs) without tooth preparation, caries removal, or local anaesthetic.

AIM

To investigate the ultrastructural, biomechanical, and chemical characteristics of teeth managed with the Hall Technique in comparison with conventional SSC (controls).

DESIGN

Twelve HT-treated primary molars and four controls were analysed. Teeth were dehydrated in ethanol, embedded in methylmethacrylate, mesio-distally sectioned, X-rayed, mounted, and polished. Biomechanical, ultrastructural, and chemical characterisation was performed for carious lesion and sound areas of each specimen.

RESULTS

Pre-treatment and post-treatment X-rays showed evidence of little to no caries progression over time. In carious lesions, mean hardness and elastic modulus values were lower in HT-treated teeth than in controls. In both controls and HT-treated teeth, carious lesions had the lowest %wt of Ca and P of all tissues sampled.

CONCLUSIONS

Although the retained carious tissue was biomechanically more compromised in HT-treated teeth, the Ca and P values were higher than reported elsewhere for carious lesions in primary molars, suggesting remineralisation may have occurred in caries in HT-treated teeth. Future investigations will help elucidate the processes involved with carious lesion arrest under SSC.

White enamel lesions in children: considering caries, chronological and congenital causes and their consequent care

White enamel lesions are a common presentation to the general dentist and aesthetic concerns are the most frequent presenting problem. Aetiology may be multifactorial and management of such lesions is heavily dependent on the cause. In the paediatric patient, differentiating white lesions caused by caries, fluorosis and genetic and developmental disorders is key to offering optimal long-term treatment outcomes. Early intervention allows for carefully planned management of less common disorders. Many of these disorders exist along a spectrum, and white lesions offer a useful clue to prompt intervention and referral to the relevant specialists. This article overviews common white lesions of the teeth and outlines the hierarchy of management options available.

Analysis of dental caries and the impact factors of caries in children aged 3-5 years old in Changdu, Xizang

OBJECTIVES

To investigate caries status and its impact factors in preschool children in plateau and to provide reference for caries prevention in highlands.

METHODS

Examination of caries was performed on 1 597 children aged 3-5 years old in 11 kindergartens in Changdu, Xizang, in accordance with the 4th National Oral Health Survey standards and methods. Their parents were surveyed with the questionnaire regarding oral hygiene habit and consciousness about oral health and related factors. All the data were collected and analyzed.

RESULTS

The prevalence of caries among children aged 3-5 years old in Changdu was 52.85%, with dmft index of 2.44. The caries rate and dmft of children aged 3 years old were lower than those of children aged 4 and 5 years old (P<0.05). No significant difference was observed in the caries rate between males and females (P>0.05). Single-factor analysis showed that the frequency of brushing teeth more than twice a day, low frequency of eating sweets, high frequency of drinking butter tea, and regular oral examination can reduce the rate of caries (P<0.05). Multivariate logistic analysis showed that the frequency of eating sweets, drinking butter tea, and oral examination are related impact factors of caries.

CONCLUSIONS

The prevalence of ca-ries in children aged 3-5 years old in Changdu increases with aging. Good oral hygiene and eating habits and regular oral examination can reduce the rate of caries.

Impact of the Brush Day & Night Programme on Well-Being, Plaque, and Dental Caries in Children

OBJECTIVES

Poor oral hygiene can have an adverse effect on quality of life. School-based interventions can establish positive behaviours that reduce the likelihood of dental caries later in life. The Brush Day & Night programme aims to encourage good oral health behaviour and improve oral health and quality-of-life outcomes. In this article, we report the effect of the programme on well-being and oral hygiene measured by plaque levels at 3, 8, and 24 weeks and dental caries at 24 weeks after programme start date.

METHODS

This was a superiority cluster randomised trial of children 6-12 years of age from Indonesia (N = 2021) and Nigeria (N = 2104). All children were provided with toothpaste and a toothbrush. Children in the intervention group received the 21-day Brush Day & Night programme, whereas those in the control group did not. Children completed a questionnaire addressing the objectives at all time points. Their oral hygiene was assessed using the Oral Hygiene Index-Simplified (OHI-S). Additionally, at baseline and 24 weeks their caries status was recorded using the decayed, missing, and filled teeth (DMFT) index.

RESULTS

In Indonesia, after participation in the programme children demonstrated a 45% increased probability of no worsening in the occurrence of decayed, missing, or filled teeth. In Nigeria, children had a 71% higher probability of having confidence in their smile and the proportion of children with good oral hygiene doubled from 40% to 80% at 24 weeks.

CONCLUSIONS

The Brush Day & Night programme was successful in improving well-being and oral hygiene in children in Nigeria and reduced the likelihood of worsening in the occurrence of decayed, missing, or filled teeth in children in Indonesia.

Parental incarceration and children's oral health in the United States: Findings from the 2016-2018 National Survey of Children's Health

OBJECTIVE

This study aimed to examine the association between parental incarceration and children's oral health in the United States and assess the degree to which household socioeconomic factors, children's healthcare insurance and oral healthcare utilization/preventive care explain this association.

METHODS

Using data from the 2016-2018 National Survey of Children's Health (NSCH; N = 99 962), a series of logistic regression models were used to investigate the association between parental incarceration and a variety of children's oral health conditions. The Karlson-Holm-Breen method was used to assess the degree to which household socioeconomic factors, children's healthcare insurance and oral healthcare utilization/preventive care visits reduced the association between parental incarceration and children's oral health.

RESULTS

Results from logistic regression analyses demonstrated that net of control variables, children of incarcerated parents have significantly worse oral health including poor or fair teeth condition (OR = 2.71, 95% CI = 2.23-3.29), toothaches (OR = 1.72, 95% CI = 1.36-2.18), gum bleeding (2.12, 95% CI = 1.52-2.94), cavities/tooth decay (OR = 1.50, 95% CI = 1.26-1.77) and are more likely to have unmet dental care needs (OR = 1.78, 95% CI = 1.28-2.46). Attenuation analyses demonstrated this relationship is partially explained by household material hardship and children's health insurance.

CONCLUSIONS

Parental incarceration is associated with worse oral health and unmet dental care needs. Household material hardship and children's health insurance partially attenuate this association. Efforts to expand oral health literacy to incarceration-exposed parents, and policies that buffer against material hardship and inadequacies in children's health insurance may be useful for improving oral health of children whose parents have been incarcerated.

Validation of a 4-item child perception questionnaire in Australian children

Objective

To develop and validate a 4-item child oral health-related quality of life (OHRQoL) instrument that might be more amenable for uptake in large scale, multifaceted surveys of children’s health and wellbeing than current, longer-form child OHRQoL instruments.

Methods

Data were obtained from a study of the South Australian School Dental Service population designed to investigate OHRQoL among school children aged 8–13 years in 2002–2003. The Child Perception Questionnaire (CPQ_8-10 and CPQ_11-14) was utilised, which comprises 25 & 37 items representing four conceptual domains: oral symptoms, functional limitations, emotional wellbeing and social wellbeing. Initially, the psychometric properties of the short form 8-item CPQ were tested in both age groups using Confirmatory Factor Analysis. The rationale was that, if the 8-item CPQ_8-10 and CPQ_11-14 did not display good psychometric properties, there was no reason to proceed with further shortening into 4-item versions. Following a good fit of the 8-item CPQ, items with higher factor loadings in each domain were maintained and tested in the development of a 4-item CPQ. Exploratory Factor Analysis was conducted to determine dimensionality, followed by tests for reliability and validity. Model fits were assessed using Root Mean Square Error of Approximation (RMSEA), Comparative Fit Index (CFI) and Standardized Root Mean Square Residual (SRMR).

Results

There were 308 children aged 8–10 years who completed CPQ_8-10 and 461 children aged 11–13 years who completed CPQ_11-14. For the short-form 8-item instrument, satisfactory goodness of fit was demonstrated for the two age groups, with acceptable thresholds for RMSEA, CFI, and SRMR. The four items with the highest factor loading in each domain were the same for the 8-item CPQ_8-10 and CPQ_11-14. and these items were selected to comprise the 4-item CPQ_8-10 and CPQ_11-14. The 4-item short form displayed good criterion validity, with expected score patterns found in the majority of the known groups evaluated.

Conclusions

We developed short-form 4-item CPQ_8-10 and CPQ_11-14 instruments that were tested in a large convenience sample of South Australian school children. The instruments demonstrated acceptable reliability and validity. Implications for practice are discussed.

Preparation of a Novel Transplant Material, Zirconium Oxide (ZrO₂) Nanotubes, and Characterizations Research

Background

Zirconia is one of the most widely used ceramic materials for transplanting and treating caries. This study aimed to synthesize zirconium oxide (ZrO₂) nanotubes and evaluated their characteristics.

Material/Methods

Zr film was prepared using an ion plating method. Nanoarray film was constructed with anodizing. Photocatalytic properties of nnanotubes were assessed by evaluating decolorization of methyl orange. Elemental analysis and structural morphology for coatings were evaluated using x-ray analysis and scanning electron microscopy (SEM). Dimensions for layers were measured with SEM imaging. X-ray diffraction (XRD) was measured using Empyrean x-ray diffractometry.

Results

There were irregular cavities on the surface of ZrO₂ nanotubes undergoing anodizing of 30V. Anodizing voltage of 45 V (with regular nano-pore arrays and smooth nanotube walls) and anodic oxidation duration of 60 min (ZrO₂ nanotubes clearly formed atop ZrO₂-coated substrate surface) were the optimal condition for ZrO₂ nanotube formation. TEM illustrated tube length of ZrO₂ nanotubes was approximately 2.01 μm. Nanotube diameter was 51.06 nm, and wall thickness was 13 to 14 nm. Annealed nanotubes showed an obvious crystal diffraction pattern. TEM diffraction ring showed nanotube array without obvious transistor structure before annealing, but with good crystallinity post-annealing. Increased annealing temperatures result in enhanced intensity for the monoclinic phase (400–800°C). After annealing at 600°C, the decolorization effect of ZrO₂ nanotubes on methyl orange was better than that post-annealing at 400 and 800°C. ZrO₂ nanotubes demonstrated higher microshear bond strength.

Conclusions

Zirconium nanotubes were successfully synthesized and demonstrated good structural characteristics, which can be applied to transplanting and treating caries.

When the fear of dentist is relevant for more than one's oral health. A structural equation model of dental fear, self-esteem, oral-health-related well-being, and general well-being

PURPOSE

To develop and test a complex model that captures the individuals' general well-being and the specific oral-health-related well-being. We were specifically interested, as a specific research question, if self-esteem, dental fear, and the oral health-related well-being are credible predictors for the general well-being.

PATIENTS AND METHODS

A one-time associative research design measured dental-specific anxiety, self-esteem, oral-health-related specific well-being, and general well-being in 281 participants, 3rd and 6th year dental students (M _Age =22.59 years, SD _Age =3.13; 55% females), which completed a battery of relevant questionnaires: the Dental Fear Survey, the Rosenberg Self-Image Scale, the short form of Oral Health Impact Profile, and the Flourishing Scale. The data were subject to structural equation modeling in order to validate potential pathways of influence hypothesized based on previous evidence from the literature.

RESULTS

We developed and tested a complex structural equations model, in which dental fear influences both the specific oral-health-related well-being and the persons' self-esteem. In turn, self-esteem mediates the influence pathways between dental fear and oral-health-specific well-being, on the one hand, and the overall well-being, on the other hand.

CONCLUSION

Our research contributes directly to strengthening the theoretical basis for future interdisciplinary research, by providing, first, a tested and replicable model that surpasses the simple correlation or prediction, and second, empirical evidence for the significant mutual interdependence between psychological experiences, eg, self-esteem, and the two main aspects of well-being, ie, specific and general. From a practical, clinical viewpoint, our research provides further insights and justification for the importance of educating the patient, on all levels, from the individual clinical practice to community programs and public oral health policies, with respect to the importance of oral health.

Knowledge, attitude and practice among Health Visitors in the United Kingdom toward children's oral health

OBJECTIVES

The purpose of this study was to determine knowledge, attitude, and practical behavior of health visitors regarding children's oral health in the United Kingdom (UK).

METHODS

A web-based self-administered survey with 18 closed and 2 open ended questions was distributed to a convenience sample of approximately 9,000 health visitors who were currently employed in the United Kingdom and a member of the Institute of Health Visiting.

RESULTS

A total of 1,088 health visitors completed the survey, resulting in a response rate of 12%. One-third of the health visitors reported that they had not received oral health training previously. Almost all agreed that oral health advice/promotion should be included in their routine health visiting contacts. Previous oral health training/education was associated with an increase in oral health knowledge; confidence in entering a discussion with parents/caregivers and willingness to be involved in dental referral process.

CONCLUSIONS

The results of our study support the need for health visitors to receive oral health training in oral health promotion including oral health risk assessment, guidance on evidence based up-to-date prevention measures, increasing the dental attendance prevalence at early stages and awareness of including specific oral health guidelines/fact sheets into their regular practice.

Survival characteristics of composite restorations in primary teeth

OBJECTIVES

This retrospective study analyzed restoration survival of composite fillings in children with at high caries risk in relation to age, sex, operator, tooth type, filling extension, and material used.

MATERIALS AND METHODS

Among 667 children treated in 2004-2012 in a university setting without sedation or general anesthesia, 2388 composite fillings were included. Relevant data from regular recall intervals were retrieved from patients' records. Either total-etch or a self-etch adhesive combined with flowable and/or (nano)hybrid composite was used. The Kaplan-Meier estimator and Cox proportional hazard analysis with backward elimination model were applied for survival analysis.

RESULTS

For the observation period of 8 years (mean 1.7 years), the cumulative failure rate was 17.2 % with annual failure rates of 10.0 %. In 8.8 % of the cases, fillings failed due to secondary caries. In 8.3 % technical failure due to total filling loss, loosening, marginal gaps, or tooth fracture occurred. Tooth type, filling extension, age, operator, dental dam, and type of adhesive were significant for survival (p < 0.05).

CONCLUSIONS

Filling survival was comparably lower to composite restorations observed in prospective clinical studies on permanent teeth and other tooth-colored restoratives used in primary teeth. Due to the very high caries risk and young age of the population, frequent loss due to secondary caries was observed. With respect to the high caries risk, composite restorations can be used to treat carious primary teeth, though a strict caries prevention regimen should be followed to minimize restoration failure.

CLINICAL RELEVANCE

Filling loss of composites in the primary dentition is associated with secondary caries on the long term.