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Herbert K, Herlitz L, Woodman J, Powell C, Morris S. Patient and caregiver characteristics associated with differential use of primary care for children and young people in the UK: a scoping review. BMJ Open 2024; 14:e078505. [PMID: 38760051 PMCID: PMC11103219 DOI: 10.1136/bmjopen-2023-078505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 04/24/2024] [Indexed: 05/19/2024] Open
Abstract
OBJECTIVE To systematically map evidence to answer the research question: What is the relationship between the characteristics of children and young people (CYP) or their caregivers and primary care service use in the UK, taking into account underlying healthcare needs? DESIGN: Scoping review. SETTING Primary care. ELIGIBILITY CRITERIA English-language quantitative or mixed-methods studies published between 2012 and 2022. DATA SOURCES Medline, Embase, Scopus and Web of Science Social Sciences Citation Index, and grey literature. RESULTS 22 eligible studies were identified, covering general practice (n=14), dental health (n=4), child mental health (MN) services (n=3) and immunisation (n=1). Only eight studies (36%) controlled for variables associated with healthcare need (eg, age, birth weight and long-term conditions). In these, evidence of horizontal inequity in primary care use was reported for CYP living in deprived areas in England, with and without complex needs. Horizontal inequity was also identified in primary care MN referrals for CYP in England identifying as mixed-race, Asian or black ethnicity, compared with their white British peers. No evidence of horizontal inequity was observed, however, in primary care use for CYP in England exposed to parental depression, or for CYP children from low-income households in Scotland. Increasing CYP's age was associated with decreasing primary care use across included studies. No studies were found regarding CYP from Gypsy or Traveller communities, children in care, or those with disabilities or special educational needs. CONCLUSIONS There is evidence that socioeconomic factors impact on CYP's primary care use, in particular age, ethnicity and deprivation. However, better quality evidence is required to evaluate horizontal inequity in use and address knowledge gaps regarding primary care use for vulnerable CYP populations and the impact of policy and practice related 'supply side' of primary care.
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Affiliation(s)
- Kevin Herbert
- Cambridge Research Methods Hub, Department of Public Health and Primary Care, Cambridge University, Cambridge, UK
| | - Lauren Herlitz
- Population, Policy and Practice Department, UCL GOS Institute of Child Health, London, UK
| | - Jenny Woodman
- Institute of Education, UCL Social Research Institute, London, UK
| | - Claire Powell
- Population, Policy and Practice Department, UCL GOS Institute of Child Health, London, UK
| | - Stephen Morris
- Cambridge Research Methods Hub, Department of Public Health and Primary Care, Cambridge University, Cambridge, UK
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Aldhuwayhi S, Bhardwaj A, Deeban YAM, Bhardwaj SS, Alammari RB, Alzunaydi A. A Narrative Review on Current Diagnostic Imaging Tools for Dentomaxillofacial Abnormalities in Children. CHILDREN 2022; 9:children9050621. [PMID: 35626798 PMCID: PMC9139436 DOI: 10.3390/children9050621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 11/16/2022]
Abstract
The current review narrates the findings and discusses the available diagnostic tools for detecting structural abnormalities. The review discusses several diagnostic tools, such as magnetic resonance imaging, cone beam computed tomography, multi detector row CT and positron emission tomography. The vital findings and comparative analysis of different diagnostic tools are presented in this review. The present review also discusses the advent of newer technologies, such as the HyperionX9 scanner with less field of view and 18F-FDG PET/CT (positron emission tomography with 2-deoxy-2-[fluorine-18] fluoro-D-glucose, integrated with computed tomography), which can give more efficient imaging of dentomaxillofacial structures. The discussion of effective comparative points enables this review to reveal the available diagnostic tools that can be used in the detection of dentomaxillofacial abnormalities in the pediatric population. The advantages and disadvantages of each tool are discussed, and the findings of past publications are also presented. Overall, this review discusses the technical details and provides a comparative analysis of updated diagnostic techniques for dentomaxillofacial diagnosis.
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Affiliation(s)
- Sami Aldhuwayhi
- Department of Prosthodontics, College of Dentistry, Majmaah University, Al Majmaah 11952, Saudi Arabia; (S.A.); (Y.A.M.D.); (R.B.A.)
| | - Atul Bhardwaj
- Department of Prosthodontics, College of Dentistry, Majmaah University, Al Majmaah 11952, Saudi Arabia; (S.A.); (Y.A.M.D.); (R.B.A.)
- Correspondence:
| | - Yahya Ahmed M. Deeban
- Department of Prosthodontics, College of Dentistry, Majmaah University, Al Majmaah 11952, Saudi Arabia; (S.A.); (Y.A.M.D.); (R.B.A.)
| | - Smita Singh Bhardwaj
- Pediatric Dentistry, Department of Preventive Dental Sciences, College of Dentistry, Majmaah University, Al Majmaah 11952, Saudi Arabia;
| | - Rawan Bakr Alammari
- Department of Prosthodontics, College of Dentistry, Majmaah University, Al Majmaah 11952, Saudi Arabia; (S.A.); (Y.A.M.D.); (R.B.A.)
| | - Ayoub Alzunaydi
- General Dentist, Ministry of Health, Al Artawiyah General Hospital, Al Artawiyah 15719, Saudi Arabia;
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Faisal MR, Mishu MP, Jahangir F, Younes S, Dogar O, Siddiqi K, Torgerson DJ. The effectiveness of behaviour change interventions delivered by non-dental health workers in promoting children’s oral health: A systematic review and meta-analysis. PLoS One 2022; 17:e0262118. [PMID: 35015771 PMCID: PMC8751985 DOI: 10.1371/journal.pone.0262118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 12/17/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives
Dental caries is the most common preventable childhood condition. Non-dental professionals and health workers are often well placed to support parents in adopting positive oral health behaviours for their children. The aim of this study was to determine the effectiveness of behaviour change interventions and their individual component behaviour change techniques (BCTs), that were delivered by non-dental professionals and health workers.
Methods
A systematic search of Ovid MEDLINE, PubMed, CINAHL, Cochrane Library, Web of Science, TRoPHI and PROQUEST from inception until March 2021 was conducted. Randomised controlled trials and quasi-experimental studies for improving oral health outcomes in children were included. Quality assessment was carried out using Cochrane Risk of Bias tool and ROBINS-I tool. Publication bias was assessed using funnel plots and Egger’s regression intercept. Effect sizes were estimated as standardised mean difference (SMD) and odds ratio/risk ratio for proportions. Meta-analyses were performed for studies reporting mean decayed, missing, filled surfaces (dmfs) and mean decayed, missing, filled, teeth (dmft) indices. Behaviour change technique coding was performed using behaviour change technique taxonomy v1 (BCTTv1).
Results
Out of the 9,101 records retrieved, 36 studies were included with 28 showing a significant effect either in clinical and/or behavioural/knowledge outcomes. Most studies (n = 21) were of poor methodological quality. The pooled SMD for caries experience showed statistically significant result for caries prevention at surface level -0.15 (95% CI -0.25, -0.04) and at the tooth level -0.24 (95% CI -0.42, -0.07). In 28 effective interventions, 27 individual BCTs were identified and the most frequently used were: “Instructions on how to perform the behaviour” and “Information about health consequences”.
Conclusion
There is low quality of evidence suggesting non-dental professionals and health workers may help improve oral health outcomes for children. To confirm these findings, further high-quality studies incorporating a variety of BCTs in their interventions for adoption of good oral health behaviours are needed.
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Affiliation(s)
- Mehreen Riaz Faisal
- Department of Health Sciences, University of York, York, United Kingdom
- * E-mail:
| | | | - Faisal Jahangir
- Department of Oral Medicine, Margalla Institute of Health Sciences, Rawalpindi, Pakistan
| | - Sabahat Younes
- Department of Community Health & Wellbeing, University of Central Lancashire, Preston, United Kingdom
| | - Omara Dogar
- Department of Health Sciences, University of York, York, United Kingdom
- Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, United Kingdom
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Diamanti I, Berdouses ED, Kavvadia K, Arapostathis KN, Polychronopoulou A, Oulis CJ. Dental Caries Prevalence and Experience (ICDAS II Criteria) of 5-, 12- and 15-Year-Old Children and Adolescents with an Immigrant Background in Greece, Compared with the Host Population: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:14. [PMID: 35010274 PMCID: PMC8751141 DOI: 10.3390/ijerph19010014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 12/10/2021] [Accepted: 12/16/2021] [Indexed: 06/14/2023]
Abstract
Evidence regarding disparities in oral health among native and immigrant child and adolescent populations in Europe is scarce. The present study aimed to determine the caries status of 5-, 12-, and 15-year-olds with an immigrant background in Greece in relation to their sociodemographic characteristics and compare their caries levels with those of their native Greek peers. A sample of 707 immigrants underwent clinical examination for caries (ICDAS II criteria), followed by a calculation of caries prevalence and experience estimates (2013-2014). Multivariable regression models assessed the effect of ethnic background on the caries experience (d3-6mfs/D3-6MFS) of the total (707 immigrants and 3702 Greeks) population, and the association between parental education level and the immigrants' d3-6mfs/D3-6MFS. Among the 5- and 12-year-olds, those with an immigrant background demonstrated higher caries rates and had unfulfilled treatment needs at higher proportions. Among 15-year-old adolescents, no considerable differences in caries status were observed according to ethnic background (native Greek or immigrant). The strength of the association between immigrant background and caries experience levels attenuated gradually with increasing age (IRR = 1.61, 1.27 and 1.10, and p = 0.001, p = 0.006 and p = 0.331 for 5-, 12- and 15-year-olds, respectively). Among the immigrants, adolescents with less educated mothers exhibited elevated caries levels. Public health strategies should prioritize immigrant children and early adolescents in order to reduce the existing ethnic disparities in oral health.
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Affiliation(s)
- Iliana Diamanti
- Department of Preventive and Community Dentistry, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | | | - Katerina Kavvadia
- Department of Dentistry, European University Cyprus, 6 Diogenous Str., 2404 Nicosia, Cyprus;
| | - Konstantinos N. Arapostathis
- Department of Paediatric Dentistry, School of Dentistry, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Argy Polychronopoulou
- Department of Preventive and Community Dentistry, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Constantine J. Oulis
- Department of Paediatric Dentistry, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece;
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Lauritano D, Moreo G, Carinci F, Campanella V, Della Vella F, Petruzzi M. Oral Health Status among Migrants from Middle- and Low-Income Countries to Europe: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212203. [PMID: 34831957 PMCID: PMC8624247 DOI: 10.3390/ijerph182212203] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/08/2021] [Accepted: 11/17/2021] [Indexed: 11/22/2022]
Abstract
Introduction. Economic inequality, political instability and globalization have contributed to the constant growth of the migration phenomenon in recent years. In particular, a total of 4.2 million people migrated to Europe during 2019 and most of them settled in Germany, France and Italy. Objectives. The objective of this study was to conduct a systematic review of studies analyzing the oral health condition among migrants from middle- and low-income countries to Europe and assessing the eventual association between their sociodemographic and socioeconomic characteristics and oral health status. Materials and Methods. A systematic review was conducted in PubMed, Cochrane Library, Scopus and Science Direct databases. After titles, abstracts and full-text examination, only 27 articles were selected on the basis of inclusion criteria and consequently included for quality assessments and data extraction. Results. Most of the studies reported a higher prevalence of caries experience, a poorer periodontal health and more difficulties in accessing dentalcare services among migrant groups compared with the non-migrant population. Inequalities were mostly associated with ethnic background, economic condition and social grade. Conclusion. Our review demonstrates the lack of dental health among migrants, underlining that their cultural beliefs and their social and economic living conditions could influence their oral health.
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Affiliation(s)
- Dorina Lauritano
- Department of Translational Medicine and for Romagna, University of Ferrara, 44121 Ferrara, Italy;
- Correspondence: ; Tel.: +39-335-679-0163
| | - Giulia Moreo
- Dental and Maxillo-Facial Surgery Unit, IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, 20122 Milan, Italy;
| | - Francesco Carinci
- Department of Translational Medicine and for Romagna, University of Ferrara, 44121 Ferrara, Italy;
| | - Vincenzo Campanella
- Department of Clinical Science and Translational Medicine, University of Rome “Tor Vergata”, 00113 Rome, Italy;
| | - Fedora Della Vella
- Interdisciplinary Department of Medicine, University of Bari, 70121 Bari, Italy; (F.D.V.); (M.P.)
| | - Massimo Petruzzi
- Interdisciplinary Department of Medicine, University of Bari, 70121 Bari, Italy; (F.D.V.); (M.P.)
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Oral Health Status, Oral Health Behaviours and Oral Health Care Utilisation Among Migrants Residing in Europe: A Systematic Review. J Immigr Minor Health 2021; 23:373-388. [PMID: 32686073 PMCID: PMC7914188 DOI: 10.1007/s10903-020-01056-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
As the reported data on oral health status among the migrants in Europe is fragmented, we systematically reviewed the published literature on the oral health status, behaviours and care utilisation among migrants residing in Europe. For this, we retrieved publications from PubMed and EMBASE, supplemented by manual citation screening and grey literature search on Google scholars. Two independent reviewers screened the studies, extracted data and critically appraised the publications. A total of 69 studies included showed higher dental caries among migrant children. But some studies on adolescents and adults reported similar or even better oral health among migrants compared to the host population, while other reported the opposite. Poor oral health behaviours were generally reported among the migrants and they frequently made use of emergency service utilisation compared to the host population. We shed light on the gaps in dental literature and make some recommendations for the future.
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Wallace A, Hodgetts V, Kirby J, Yesudian G, Nasse H, Zaitoun H, Marshman Z, Gilchrist F. Evaluation of a new paediatric dentistry intravenous sedation service. Br Dent J 2021:10.1038/s41415-021-2700-1. [PMID: 33707732 DOI: 10.1038/s41415-021-2700-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/02/2020] [Indexed: 11/08/2022]
Abstract
Introduction Intravenous sedation (IVS) with propofol offers an alternative to inhalation sedation or general anaesthesia (GA) for dentally anxious young people who require treatment. It offers a greater level of anxiolysis than inhalation sedation and reduced morbidity when compared with GA.Methods Data were collected prospectively from a convenience sample of children requiring IVS. Participants completed the Children's Experiences of Dental Anxiety Measure (CEDAM) at the start of every visit. Patient demographics, treatment completed, surgery and recovery time were recorded. Feedback was obtained following their first visit.Results Treatment was successful for 91.5% (43/47) of patients. The average surgery and discharge time was 32.9 (8-105 minutes) and 33.1 (5-84 minutes), respectively. The CEDAM scores were between 14 and 30 (mean score 20.8). Thematic content analysis of the feedback was carried out and themes relating to communication, environment, appointment times, service satisfaction and advice to other patients emerged.Discussion CEDAM scores may have been lower than expected due to under-reporting by patients or clinicians' perception of higher anxiety levels. Feedback was reviewed regularly and improvements made where possible.Conclusion The majority of patients successfully received dental treatment under IVS. Changes have been made to the service to improve patient experience and maximise productivity.
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Affiliation(s)
- Ann Wallace
- Paediatric Dentistry, Charles Clifford Dental Hospital, 76 Wellesley Road, Sheffield, S10 2SZ, UK.
| | | | - Jen Kirby
- Paediatric Dentistry, Charles Clifford Dental Hospital, 76 Wellesley Road, Sheffield, S10 2SZ, UK
| | - Grainne Yesudian
- Paediatric Dentistry, Charles Clifford Dental Hospital, 76 Wellesley Road, Sheffield, S10 2SZ, UK
| | | | - Halla Zaitoun
- Paediatric Dentistry, Charles Clifford Dental Hospital, 76 Wellesley Road, Sheffield, S10 2SZ, UK
| | - Zoe Marshman
- School of Clinical Dentistry, University of Sheffield, Oral Health and Development, Claremont Crescent, Sheffield, S10 2TA, UK
| | - Fiona Gilchrist
- School of Clinical Dentistry, University of Sheffield, Oral Health and Development, Claremont Crescent, Sheffield, S10 2TA, UK
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Elaine Muirhead V, Milner A, Freeman R, Doughty J, Macdonald ME. What is intersectionality and why is it important in oral health research? Community Dent Oral Epidemiol 2020; 48:464-470. [PMID: 32840901 DOI: 10.1111/cdoe.12573] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/10/2020] [Accepted: 08/03/2020] [Indexed: 11/26/2022]
Abstract
This paper is the second of two reviews that seek to stimulate debate on new and neglected avenues in oral health research. The first commissioned narrative review, "Inclusion oral health: Advancing a theoretical framework for policy, research and practice", published in February 2020, explored social exclusion, othering and intersectionality. In it, we argued that people who experience social exclusion face a "triple threat": they are separated from mainstream society, stigmatized by the dental profession, and severed from wider health and social care systems because of the disconnection between oral health and general health. We proposed a definition of inclusion oral health and a theoretical framework to advance the policy, research and practice agenda. This second review delves further into the concept of intersectionality, arguing that individuals who are socially excluded experience multiple forms of discrimination, stigma and disadvantage that reflect intersecting social identities. We first provide a theoretical and historical overview of intersectionality, rooted in Black feminist ideologies in the United States. Our working definition of intersectionality, requiring the simultaneous appreciation of multiple social identities, an examination of power and inequality, and a recognition of changing social contexts, then sets the scene for examining existing applications of intersectionality in oral health research. A critique of the sparse application of intersectionality in oral health research highlights missed opportunities and shortcomings related to paradigmatic and epistemological differences, a lack of robust theoretically engaged quantitative and mixed methods research, and a failure to sufficiently consider power from an intersectionality perspective. The final section proposes a framework to guide future oral health research that embraces an intersectionality agenda consisting of descriptive research to deepen our understanding of intersectionality, and transformative research to tackle social injustice and inequities through participatory research and co-production.
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Affiliation(s)
- Vanessa Elaine Muirhead
- Centre for Dental Public Health and Primary Care, Institute of Dentistry, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Adrienne Milner
- College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK
| | - Ruth Freeman
- Dental Health Services Research Unit, School of Dentistry, University of Dundee, Dundee, UK
| | - Janine Doughty
- Pathway Homelessness and Inclusion Oral Health Fellow, University College London Hospitals NHS Foundation Trust, London, UK
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Lakhanpaul M, Benton L, Lloyd-Houldey O, Manikam L, Rosenthal DM, Allaham S, Heys M. Nurture Early for Optimal Nutrition (NEON) programme: qualitative study of drivers of infant feeding and care practices in a British-Bangladeshi population. BMJ Open 2020; 10:e035347. [PMID: 32565459 PMCID: PMC7307527 DOI: 10.1136/bmjopen-2019-035347] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES To explore optimal infant feeding and care practices and their drivers within the British-Bangladeshi population of East London, UK, as an exemplar to inform development of a tailored, coadapted participatory community intervention. DESIGN Qualitative community-based participatory research. SETTING Community and children's centres and National Health Service settings within Tower Hamlets, London, UK. PARTICIPANTS 141 participants completed the community study including: British-Bangladeshi mothers, fathers, grandmothers and grandfathers of infants and young children aged 6-23 months, key informants and lay community members from the British-Bangladeshi population of Tower Hamlets, and health professionals working in Tower Hamlets. RESULTS 141 participants from all settings and generations identified several infant feeding and care practices and wider socioecological factors that could be targeted to optimise nutritional outcomes. Our modifiable infant feeding and care practices were highlighted: untimely introduction of semi and solid foods, overfeeding, prolonged parent-led feeding and feeding to 'fill the belly'. Wider socioecological determinants were highlighted, categorised here as: (1) society and culture (e.g. equating 'chubby baby' to healthy baby), (2) physical and local environment (e.g. fast food outlets, advertising) and (3) information and awareness (e.g. communication with healthcare professionals around cultural norms). CONCLUSIONS Parenting interventions should be codeveloped with communities and tailored to recognise and take account of social and cultural norms and influence from different generations that inform infant feeding and care practices and may be of particular importance for infants from ethnically diverse communities. In addition, UK infant feeding environment requires better regulation of marketing of foods for infants and young children if it is to optimise nutrition in the early years.
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Affiliation(s)
- Monica Lakhanpaul
- Population, Policy and Practice, University College London Institute of Child Health, London, UK
- Whittington Health NHS Trust, London, UK
| | - Lorna Benton
- Population, Policy and Practice, University College London Institute of Child Health, London, UK
| | - Oliver Lloyd-Houldey
- Population, Policy and Practice, University College London Institute of Child Health, London, UK
| | - Logan Manikam
- Department of Epidemiology and Public Health, University College London Institute of Epidemiology and Health Care, London, UK
- Aceso Global Health Consultants Ltd, London, UK
| | - Diana Margot Rosenthal
- Population, Policy and Practice, University College London Institute of Child Health, London, UK
| | - Shereen Allaham
- Department of Epidemiology and Public Health, University College London Institute of Epidemiology and Health Care, London, UK
- Aceso Global Health Consultants Ltd, London, UK
| | - Michelle Heys
- Population, Policy and Practice, University College London Institute of Child Health, London, UK
- Specialist Children's and Young People's Services, East London NHS Foundation Trust, London, Newham, UK
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Prevalence of Caries and Associated Risk Factors in a Representative Group of Preschool Children from an Urban Area with High Income in Milan Province, Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103372. [PMID: 32408678 PMCID: PMC7277466 DOI: 10.3390/ijerph17103372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/03/2020] [Accepted: 05/08/2020] [Indexed: 12/12/2022]
Abstract
The present survey provides a quantitative assessment of caries prevalence, covering a group of 3–5 year-old children from an urban area generally with a high income in the province of Milan, and a comparison of the obtained results with the data presented by the W.H.O. A cross-sectional study was conducted in the period from March to September 2018 to investigate the prevalence of caries in a sample of 160 children (82 females and 78 males). The absence/presence of caries was defined as a dependent variable. Factors concerning lifestyle, diet, oral habits, oral hygiene, the presence and type of malocclusion and mouth breathing attitude were considered as risk factors. Data were analyzed by Chi-square (χ2) and regression tests using SPSS (version 25.0) software. In total, 84.38% of children (135 out of 160) showed no caries. A regression analysis demonstrated that children who had already received an early first dental visit were mostly those already affected by caries. Furthermore, children who had four meals daily or more were less exposed to the risk of developing caries compared to those who had only 1–3 meals daily. The caries prevalence of preschool children from urban areas with a high income in Milan province is relatively close to that considered acceptable by the W.H.O. in its proposed goals for the year 2020. Therefore, it can be concluded from the obtained results that there is a possibility for further improvement in preventing caries growth at its initial stage: it is necessary for the number of meals daily consumed by children to be controlled by parents, and conducting a dental visit early in childhood must not be neglected.
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Rouxel P, Chandola T. Socioeconomic and ethnic inequalities in oral health among children and adolescents living in England, Wales and Northern Ireland. Community Dent Oral Epidemiol 2018; 46:426-434. [PMID: 29888400 PMCID: PMC6849874 DOI: 10.1111/cdoe.12390] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 05/08/2018] [Indexed: 11/29/2022]
Abstract
Objectives Although adolescence is a sensitive developmental period in oral health, the social equalization hypothesis that suggests health inequalities attenuate in adolescence has not been examined. This study analyses whether the socioeconomic gap and ethnic disadvantage in oral health among children aged 5 reduces among adolescents aged 15. Methods Data from the cross‐sectional Children's Dental Health Survey 2013 were analysed, comprising of 8541 children aged 5, 8, 12 and 15 attending schools in England, Wales and Northern Ireland. Oral health indicators included decayed and filled teeth, plaque, gingivitis and periodontal health. Ethnicity was measured using the 2011 UK census ethnic categories. Socioeconomic position was measured by family, school and residential deprivation. Negative binomial and probit regression models estimated the levels of oral health by ethnicity and socioeconomic position, adjusted for demographic and tooth characteristics. Results The predicted rate of decayed teeth for White British/Irish children aged 5 was 1.54 (95%CI 1.30‐1.77). In contrast, the predicted rate for Indian and Pakistani children was about 2‐2.5 times higher. At age 15, ethnic differences had reduced considerably. Family deprivation was associated with higher levels of tooth decay among younger children but not among adolescents aged 15. The influence of residential deprivation on the rate of tooth decay and filled teeth was similar among younger and older children. Moreover, inequalities in poor periodontal health by residential deprivation was significantly greater among 15‐year‐old children compared to younger children. Conclusions This study found some evidence of smaller ethnic and family socioeconomic differences in oral health among British adolescents compared to younger children. However, substantial differences in oral health by residential deprivation remain among adolescents. Community levels of deprivation may be particularly important for the health of adolescents.
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Affiliation(s)
- Patrick Rouxel
- CLOSER, Department of Social Science, University College London Institute of Education, London, UK.,UCL Eastman Dental Institute, London, UK
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12
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Shi C, Faris P, McNeil DA, Patterson S, Potestio ML, Thawer S, McLaren L. Ethnic disparities in children's oral health: findings from a population-based survey of grade 1 and 2 schoolchildren in Alberta, Canada. BMC Oral Health 2018; 18:1. [PMID: 29301577 PMCID: PMC5753483 DOI: 10.1186/s12903-017-0444-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 12/07/2017] [Indexed: 12/04/2022] Open
Abstract
Background Although oral health has improved remarkably in recent decades, not all populations have benefited equally. Ethnic identity, and in particular visible minority status, has been identified as an important risk factor for poor oral health. Canadian research on ethnic disparities in oral health is extremely limited. The aim of this study was to examine ethnic disparities in oral health outcomes and to assess the extent to which ethnic disparities could be accounted for by demographic, socioeconomic and caries-related behavioral factors, among a population-based sample of grade 1 and 2 schoolchildren (age range: 5-8 years) in Alberta, Canada. Methods A dental survey (administered during 2013-14) included a mouth examination and parent questionnaire. Oral health outcomes included: 1) percentage of children with dental caries; 2) number of decayed, extracted/missing (due to caries) and filled teeth; 3) percentage of children with two or more teeth with untreated caries; and 4) percentage of children with parental-ratings of fair or poor oral health. We used multivariable regression analysis to examine ethnic disparities in oral health, adjusting for demographic, socioeconomic and caries-related behavioral variables. Results We observed significant ethnic disparities in children’s oral health. Most visible minority groups, particularly Filipino and Arab, as well as Indigenous children, were more likely to have worse oral health than White populations. In particular, Filipino children had an almost 5-fold higher odds of having severe untreated dental problems (2 or more teeth with untreated caries) than White children. Adjustment for demographic, socioeconomic, and caries-related behavior variables attenuated but did not eliminate ethnic disparities in oral health, with the exception of Latin American children whose outcomes did not differ significantly from White populations after adjustment. Conclusions Significant ethnic disparities in oral health exist in Alberta, Canada, even when adjusting for demographic, socioeconomic and caries-related behavioral factors, with Filipino, Arab, and Indigenous children being the most affected. Electronic supplementary material The online version of this article (10.1186/s12903-017-0444-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Congshi Shi
- Department of Community Health Sciences, University of Calgary, TRW3, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada
| | - Peter Faris
- Alberta Health Services, Calgary, AB, Canada
| | - Deborah A McNeil
- Department of Community Health Sciences, University of Calgary, TRW3, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada.,Alberta Health Services, Calgary, AB, Canada.,Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Steven Patterson
- School of Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Melissa L Potestio
- Department of Community Health Sciences, University of Calgary, TRW3, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada.,Alberta Health Services, Calgary, AB, Canada
| | - Salima Thawer
- Department of Community Health Sciences, University of Calgary, TRW3, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada.,School of Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Lindsay McLaren
- Department of Community Health Sciences, University of Calgary, TRW3, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada.
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13
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FERNÁNDEZ MR, GOETTEMS ML, DEMARCO FF, CORRÊA MB. Is obesity associated to dental caries in Brazilian schoolchildren? Braz Oral Res 2017; 31:e83. [DOI: 10.1590/1807-3107bor-2017.vol31.0083] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 08/22/2017] [Indexed: 11/22/2022] Open
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14
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Busby M, Fayle S, Chapple L, Clover H, Chapple I. Practitioner evaluation of an online oral health and risk assessment tool for young patients. Br Dent J 2017; 223:595-599. [PMID: 29026188 DOI: 10.1038/sj.bdj.2017.841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2017] [Indexed: 11/09/2022]
Abstract
Aim To test the validity and acceptability of an online oral health assessment and biofeedback tool for young patients (under 17) for use in general dental practice.Methods A convenience sample of thirteen practitioners were recruited to test the functionality of a novel version of the Denplan PreViser Patient Assessment tool (DEPPA) developed for young patients (YDEPPA). Dentists who had completed eight or more assessments during a one month window were sent a link to an online feedback survey, comprising eight statements about YDEPPA, with scoring options of 0-10, where a score of 10 indicated complete agreement with the relevant questions. Verbatim comments were encouraged. The clinical data submitted were held in a central database in an encrypted format so that only the user practice could identify individual patients.Results Twelve practitioners completed eight or more assessments and were included in the survey. A total of 175 patient assessments were received. Ten practitioners completed the on-line survey. The statement 'YDEPPA produces a valid measurement of each patient's oral health' received an average feedback score of 8.8. The statement 'The full YDEPPA report is a valuable communication aid' received a score of 9.6. Feedback was generally very positive with all scores >8.2. Constructive critical feedback was received for the caries risk aspect of the YDEPPA protocol, with suggestions made for improving objectivity of data inputs. Eighty-one percent of the verbatim comments received were positive.Conclusions Once the caries risk issues raised by pilot dentists have been addressed, YDEPPA appears suitable as a pragmatic analytical and biofeedback tool for use in general dental practice to assess the oral health of young patients, and to facilitate education and engagement of young patients and their parents/carers in positive health behaviours.
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Affiliation(s)
- M Busby
- Primary Dental Care University of Birmingham, The Stables, Heritage Ct, Clifton Reynes, Olney, MK46 5FW
| | - S Fayle
- Consultant in Paediatric Dentistry, Clarendon Way, Leeds, LS2 9LU
| | - L Chapple
- Managing Director Oral Health Innovations Ltd, Birmingham Research Park, Vincent Drive, Birmingham, B15 2SQ
| | - H Clover
- Head of Dental Policy Denplan Ltd, Denplan Court, Victoria Road, Winchester, SO23 7RG
| | - I Chapple
- Restorative Dentistry Head of School of Dentistry and Periodontal Research Group, College of Medical and Dental Sciences and Birmingham Community Healthcare Foundation Trust, Birmingham Dental School, 5 Mill Pool Way, Edgbaston, Birmingham, B5 7EG
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15
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Comparing the profile of child patients attending dental general anaesthesia and conscious sedation services. Br Dent J 2017; 222:683-687. [DOI: 10.1038/sj.bdj.2017.406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2017] [Indexed: 12/15/2022]
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16
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Delgado-Angulo EK, Bernabé E, Marcenes W. Ethnic inequalities in periodontal disease among British adults. J Clin Periodontol 2016; 43:926-933. [DOI: 10.1111/jcpe.12605] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2016] [Indexed: 12/15/2022]
Affiliation(s)
- Elsa K. Delgado-Angulo
- Division of Population and Patient Health; King's College London Dental Institute at Guy's; King's College and St. Thomas’ Hospitals; London UK
- Departamento Académico de Odontología Social; Universidad Peruana Cayetano Heredia; Lima Perú
| | - Eduardo Bernabé
- Division of Population and Patient Health; King's College London Dental Institute at Guy's; King's College and St. Thomas’ Hospitals; London UK
| | - Wagner Marcenes
- Institute of Dentistry; Barts and The London School of Medicine and Dentistry; Queen Mary University of London; London UK
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17
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Marshman Z, Ahern S, McEachan R, Rogers H, Gray-Burrows K, Day P. Parents' Experiences of Toothbrushing with Children: A Qualitative Study. JDR Clin Trans Res 2016; 1:122-130. [PMID: 28879241 PMCID: PMC5576048 DOI: 10.1177/2380084416647727] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Globally, dental caries is one of the most prevalent diseases and is more common in children living in deprived areas. Dental caries is preventable, and guidance in the United Kingdom recommends parental supervised brushing (PSB): a collection of behaviors-including twice-daily toothbrushing with fluoridated toothpaste-that should begin upon eruption of the first tooth (approximately 6 to 12 mo of age) and for which children need to be helped or supervised by an adult until at least 7 y of age. The aim of this study was to explore parents' experiences of toothbrushing with their young children and to establish barriers and facilitators to PSB at individual, interpersonal, and environmental levels according to the theoretical domains framework. Qualitative semistructured interviews guided by the framework were conducted with 27 parents of young children (<7 y) in 2 deprived areas of the United Kingdom. Framework analysis was used. Parents were not aware of national guidance concerning their active involvement in toothbrushing; however, they did have detailed knowledge of toothbrushing practices for children, and their intentions were to brush their children's teeth themselves twice every day as part of a family routine. Nonetheless, parents' difficulties experienced in managing their children's challenging behavior and the environmental context of their stressful lives meant that many parents adopted a role of simply reminding their children to brush or watching them brush. As such, the main barriers to PSB among parents living in deprived areas were skills in managing their children's behavior and environmental influences on family life. The results of our study have clear implications for the development of appropriate interventions to address the modifiable barriers to improve parental adoption of PSB. Knowledge Transfer Statement: The results of this study will be used to develop a behavior change intervention to encourage parental supervised brushing. The intervention-which is likely to be delivered through health practitioners rather than dental teams-will be developed to reduce dental caries among young children and will require evaluation in terms of its clinical and cost effectiveness.
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Affiliation(s)
| | - S.M. Ahern
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - R.R.C. McEachan
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - H.J. Rogers
- Department of Paediatric Dentistry, Charles Clifford Dental Hospital, Sheffield, UK
| | | | - P.F. Day
- School of Dentistry, University of Leeds, Leeds, UK
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18
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PINTO GDS, HARTWIG AD, ELIAS R, AZEVEDO MS, GOETTEMS ML, CORREA MB, DEMARCO FF. Maternal care influence on children’s caries prevalence in southern Brazil. Braz Oral Res 2016; 30:S1806-83242016000100262. [DOI: 10.1590/1807-3107bor-2016.vol30.0070] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 03/31/2016] [Indexed: 11/22/2022] Open
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Drummond AMA, Ferreira EF, Gomes VE, Marcenes W. Inequality of Experience of Dental Caries between Different Ethnic Groups of Brazilians Aged 15 to 19 Years. PLoS One 2015; 10:e0145553. [PMID: 26694321 PMCID: PMC4692284 DOI: 10.1371/journal.pone.0145553] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 12/04/2015] [Indexed: 11/18/2022] Open
Abstract
Introduction The aim of this study was to assess inequality of experience of dental caries, based on race/ethnicity, among Brazilian adolescents aged 15 to 19 years in 2010 and test whether socioeconomic indicators fully explain ethnic differences in dental caries. Methods Data from a National Oral Health Survey conducted in Brazil in 2010 was analysed. Race/ethnicity was self-assigned and modified to White, African descents, East Asian descents, Mixed Race and Indigenous descents. The prevalence of caries experience by race/ethnic group in 2010(n = 5,367) was calculated. Further analysis included conceptual hierarchical modelling and mediation analysis. Results Caries experience was 76.9% in 15 to 19 year old Brazilians in 2010. While African descents were 32% more likely to have caries experience than Whites, Mixed Race were 69% more likely to have caries experience than Whites. Hierarchical conceptual modelling analysis confirmed the highly significant association between caries and race/ethnicity. Mixed Race and East Asian descents were 1.44 (95% CI 1.24–1.67) and 1.81 (95% CI 1.02–3.20) times more likely to experience caries than Whites after adjusting for age, sex, education and income. The difference in the likelihood of experiencing caries between Whites and African descents was not statistically significant after adjusting for years of education and family income. The results of mediation analysis confirmed that inequality of caries experience between Whites and Mixed Race and East Asian descents was mediated through education and income. The likelihood that Mixed Race and East Asian descents would experience caries compared to Whites was attenuated, by 14.8% and by 9.5% respectively, after adjusting for years of education and income. Conclusions Data analysis demonstrated that Whites have benefited more from the significant reduction in dental caries experience in 15 to 19 year old Brazilians, as compared to African descents and Mixed Race. Education and income fully explained ethnic inequalities in experience of dental caries between Whites and African descents, and largely explained inequalities between Whites and Mixed Race.
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Affiliation(s)
- Andreia Maria Araújo Drummond
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London. London, United Kingdom
- Faculty of Dentistry, Universidade Federal de Minas Gerais. Belo Horizonte, Minas Gerais, Brazil
- * E-mail:
| | | | - Viviane Elisangela Gomes
- Faculty of Dentistry, Universidade Federal de Minas Gerais. Belo Horizonte, Minas Gerais, Brazil
| | - Wagner Marcenes
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London. London, United Kingdom
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20
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Delgado-Angulo EK, Bernabé E, Marcenes W. Ethnic inequalities in dental caries among adults in East London. J Public Health (Oxf) 2015; 38:e55-62. [DOI: 10.1093/pubmed/fdv097] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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21
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Gibbs L, Waters E, Christian B, Gold L, Young D, de Silva A, Calache H, Gussy M, Watt R, Riggs E, Tadic M, Hall M, Gondal I, Pradel V, Moore L. Teeth Tales: a community-based child oral health promotion trial with migrant families in Australia. BMJ Open 2015; 5:e007321. [PMID: 26068509 PMCID: PMC4466605 DOI: 10.1136/bmjopen-2014-007321] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The Teeth Tales trial aimed to establish a model for child oral health promotion for culturally diverse communities in Australia. DESIGN An exploratory trial implementing a community-based child oral health promotion intervention for Australian families from migrant backgrounds. Mixed method, longitudinal evaluation. SETTING The intervention was based in Moreland, a culturally diverse locality in Melbourne, Australia. PARTICIPANTS Families with 1-4-year-old children, self-identified as being from Iraqi, Lebanese or Pakistani backgrounds residing in Melbourne. Participants residing close to the intervention site were allocated to intervention. INTERVENTION The intervention was conducted over 5 months and comprised community oral health education sessions led by peer educators and follow-up health messages. OUTCOME MEASURES This paper reports on the intervention impacts, process evaluation and descriptive analysis of health, knowledge and behavioural changes 18 months after baseline data collection. RESULTS Significant differences in the Debris Index (OR=0.44 (0.22 to 0.88)) and the Modified Gingival Index (OR=0.34 (0.19 to 0.61)) indicated increased tooth brushing and/or improved toothbrushing technique in the intervention group. An increased proportion of intervention parents, compared to those in the comparison group reported that they had been shown how to brush their child's teeth (OR=2.65 (1.49 to 4.69)). Process evaluation results highlighted the problems with recruitment and retention of the study sample (275 complete case families). The child dental screening encouraged involvement in the study, as did linking attendance with other community/cultural activities. CONCLUSIONS The Teeth Tales intervention was promising in terms of improving oral hygiene and parent knowledge of tooth brushing technique. Adaptations to delivery of the intervention are required to increase uptake and likely impact. A future cluster randomised controlled trial would provide strongest evidence of effectiveness if appropriate to the community, cultural and economic context. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12611000532909).
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Affiliation(s)
- Lisa Gibbs
- Jack Brockhoff Child Health and Wellbeing Program, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Elizabeth Waters
- Jack Brockhoff Child Health and Wellbeing Program, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Bradley Christian
- Jack Brockhoff Child Health and Wellbeing Program, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Lisa Gold
- Deakin Health Economics, Deakin University, Burwood, Victoria, Australia
| | - Dana Young
- Jack Brockhoff Child Health and Wellbeing Program, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
- Merri Community Health Services, Brunswick, Victoria, Australila
| | - Andrea de Silva
- Dental Health Services Victoria, Carlton, Victoria, Australia
- Melbourne Dental Health School, University of Melbourne, Carlton, Victoria, Australia
| | - Hanny Calache
- Dental Health Services Victoria, Carlton, Victoria, Australia
| | - Mark Gussy
- Department of Dentistry and Oral Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Richard Watt
- Epidemiology and Public Health, University College London, London, UK
| | - Elisha Riggs
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Carlton, Victoria, Australia
| | - Maryanne Tadic
- Merri Community Health Services, Brunswick, Victoria, Australila
| | - Martin Hall
- North Richmond Community Health Limited, Richmond, Victoria, Australia
| | - Iqbal Gondal
- Internet Commerce Security Lab, Federation University Australia and Pakistan Australia Association Melbourne, Caulfield, Victoria, Australia
| | - Veronika Pradel
- Merri Community Health Services, Brunswick, Victoria, Australila
| | - Laurence Moore
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Donovan TE, Marzola R, Becker W, Cagna DR, Eichmiller F, McKee JR, Metz JE, Albouy JP. Annual review of selected scientific literature: report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 2014; 112:1038-87. [PMID: 25443419 DOI: 10.1016/j.prosdent.2014.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 09/02/2014] [Accepted: 09/02/2014] [Indexed: 12/14/2022]
Affiliation(s)
- Terence E Donovan
- Chair, Committee on Scientific Investigation, American Academy of Restorative Dentistry (AARD); Professor and Section Head for Biomaterials, Department of Operative Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | | | - William Becker
- Clinical Professor, Advanced Education in Prosthodontics, Herman Ostrow School of Dentistry, University of Southern California; private practice, Tucson, Ariz
| | - David R Cagna
- Associate Dean, Professor and Director, Advanced Prosthodontics, University of Tennessee, Health Science Center, College of Dentistry, Memphis, Tenn
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