Dental erosion and soft drinks: a qualitative assessment of knowledge, attitude and behaviour using focus groups of schoolchildren. A preliminary study

The extent and nature of children's involvement in food practice research: a scoping review of qualitative studies

OBJECTIVE

Aligning with the United Nations Convention on the Rights of the Child, amplification of children's voice in food practice research aims to inform initiatives that cater to children's needs and thus improve nutritional outcomes. The aim of this study was to describe children's (aged 6-11 years) involvement across qualitative research investigating their food practice perspectives.

DESIGN

A scoping review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR). Six electronic databases were searched up until March 2023 (Cochrane, CINAHL, Embase, ERIC, Medline and PsychInfo). The Wellcome Framework for young people's involvement in health research guided data extraction. Data were described according to inclusiveness, geography, food-related study topic, research stage and method, and child involvement.

RESULTS

The search identified 120 peer-reviewed studies (134 papers). Active participation was only seen within research implementation stages (i.e. data collection (n 134), analysis (n 31), dissemination (n 9) and re-design (n 7)). More passive forms of participation were identified in research design stages (i.e. agenda setting, resourcing and design). Studies that utilised participatory research methodologies and developmentally appropriate and engaging methods (e.g. PhotoVoice) saw more active participation by children.

CONCLUSION

This review identified a lack of opportunities for children's active participation in all stages of food practice research. Without a radical shift towards providing these opportunities, food and nutrition initiatives, policies or further research that do not meet the needs of children's food-related worlds will continue to be developed. Instead, researchers and their institutions need to advocate for and, where possible, provide voluntary opportunities for children to actively participate in food practice research.

Knowledge about caries and erosive tooth wear is confused among Norwegian high school students

OBJECTIVES

This study investigated differences in high school students' subjective and objective knowledge- and concerns about preventing caries and/or erosive tooth wear and the associations between these variables.

MATERIALS AND METHODS

A survey was conducted among students at 16 high schools in Norway. The survey included a range of fact-based questions to measure objective knowledge about caries and erosive tooth wear, as well as questions about students' perceptions of his/her own knowledge (subjective knowledge) and concerns about preventing the two conditions.

RESULTS

There were small differences in subjective knowledge about caries and erosive tooth wear among the 784 students who completed the survey (p < .01). However, students scored significantly higher on objective knowledge about caries (mean 2.99) than about erosive tooth wear (mean 1.45), p < .01, and seemed to confuse the two conditions. By contrast, students scored significantly worse on questions about beverages' potential to cause caries (mean 5.18) than to cause erosive tooth wear (mean 6.30), p < .001. Finally, objective knowledge about caries was positively associated with subjective knowledge about caries, but corresponding associations could not be found for erosive tooth wear.

CONCLUSIONS

Knowledge about caries and erosive tooth wear seemed to be confused among Norwegian high school students.

Consumption of acidic drinks, knowledge and concern about dental erosive wear in Norwegian high school students

OBJECTIVES

The objectives of the present study were to assess the consumption of acidic beverages, knowledge and concern about preventing dental erosive wear, and to examine potential associations between these variables, in a sample of high school students.

MATERIALS AND METHODS

A survey measuring acidic beverage consumption, knowledge and concern about erosive tooth wear was conducted at 13 high schools in Rogaland county, Norway.

RESULTS

Of the 850 students who completed the questionnaire, 26% reported that they drink acidic beverages every day. There were significant gender differences for the consumption of acidic drinks. The survey also demonstrated that a high proportion of students lacks basic knowledge of what erosive tooth wear is, and that this lack of knowledge is associated with a more frequent intake of acidic beverages. However, students who responded that they are concerned about preventing dental erosive wear reported that they drink soft drinks and energy drinks less frequently than students who are not concerned about this.

CONCLUSIONS

Results from this study support assumptions about a lack of knowledge about dental erosive wear in youth, and that this lack of knowledge is associated with a more frequent intake of acidic drinks.

Effects of citric acid modified with fluoride, nano-hydroxyapatite and casein on eroded enamel

OBJECTIVES

The aim of this in vitro study was to evaluate the effects of citric acid containing fluoride, nano-hydroxyapatite, and casein on eroded enamel.

DESIGN

The crowns of 120 extracted bovine incisors were embedded in acrylic resin. An enamel window (2 × 3 mm) was created on the surface. Before in vitro pellicle formation samples were eroded in 1% citric acid (pH = 3.2) for 1 h at 36 °C and were randomly classified to eight groups (n = 15) as follows: Positive control: 1% citric acid, Negative control: Distilled water, F1: 0.047 mmol/L sodium fluoride, F2: 0.071 mmol/L sodium fluoride, NHA1: %0.05 Nano-Hydroxyapatite, NHA2: %0.1 Nano-Hydroxyapatite, C1: %0.02 Casein, C2: %0.2 Casein. Erosion cycling was performed three times daily for 3 days. In each cycle, the samples were immersed in 10 mL of control or modified solutions (10 min) and in 10 mL of artificial saliva (60 min). The surface roughness and enamel loss were analyzed by using profilometer, scanning electron microscopy (SEM) and atomic force microscopy techniques (AFM).

RESULTS

Among the groups, the positive control group was found to be having the highest erosive wear. Erosive wear in the F2, NHA2, C1, and C2 groups was not significantly different from the negative control group (p > 0.05). The C1 and C2 groups showed that erosion terminated and minimal tissue recovery occurred on the enamel surface.

CONCLUSION

Although all modifications reduced further demineralization, the citric acid modification with casein was found to be having a greater impact on dental erosion than the others.

Repeated exposure of acidic beverages on esthetic restorative materials: An in-vitro surface microhardness study

Background

A manifold increase in the consumption of aerated beverages has witnessed a twin increase in tooth wear and raised demand for esthetic restorative materials. This study aimed to evaluate the surface microhardness changes of esthetic restorative materials following treatment with aerated beverages in an in-vitro situation.

Material and Methods

The initial surface microhardness of the restorative materials GC Fuji II LC, GC Fuji IX, Nano Glass ionomer, Resin and Nano composite was recorded. These materials were studied under 3 groups that included those exposed to the acidic beverages daily, weekly once in a month and those that had no exposures at all. The final surface microhardness of the materials was recorded following experimentation and was subjected to statistical comparisons.

Results

The restorative materials were compared for their surface microhardness changes following respective treatments using the T-test and One-way ANOVA analysis. Inter-comparisons between the groups showed statistical significance (p<.05), when treated with both the beverages. The five restorative materials revealed surface microhardness loss; the maximum reduction noticed with the Nano glass ionomer cement tested (p<.0005).

Conclusions

The surface microhardness of restorative materials markedly reduced upon repeated exposures with acidic beverages; the product with phosphoric acid producing the maximum surface microhardness loss.

Key words:Restorative materials, acidic beverages, surface microhardness, resin composites, glass ionomers.

A qualitative study of the views of adolescents on their caries risk and prevention behaviours

Background

The purpose of this study was to explore the attitudes and beliefs of adolescents towards dental caries and their use or non-use of caries prevention regimens.

Methods

Adolescents aged 16 years from four state-funded secondary schools in North West of England (n = 19). Purposive sampling strategically selected participants with characteristics to inform the study aims (gender, ethnicity, and caries status). Semi-structured interviews were transcribed verbatim and analysed using a framework approach.

Results

14 codes within five overarching themes were identified: “Personal definition and understanding of oral health”; “Knowledge of oral health determinants”; “Influences on oral health care”; Reason for oral health behaviours”; and “Oral health in the future”. Adolescents conceptualise oral health as the absence of oral pathology and the ability to function, which included an aesthetic component. Appearing to have healthy teeth was socially desirable and equated with positive self-image. The dominant influence over oral health behaviours was habitual practice encouraged by parents from a young age, with limited reinforcement at school or by dental practices. At this transitional age, participants recognised the increasing influence of peers over health behaviours. Self-efficacy pertained to diet modification (reduction in sugar-ingestion) and oral hygiene behaviour (tooth-brushing). A lack of understanding of caries aetiology was evident. Behaviours were mitigated by a lack of environmental support; and a desire for immediate gratification often overcame attempts at risk-reducing behaviour.

Conclusions

Parents primarily influence the habitual behaviours of adolescents. With age, the external environment (availability of sugar and peers) has an increasing influence on behaviour. This suggests that to improve adolescent health, oral health promoters should engage with parents from early childhood and create supportive environments including public policy on sugar availability to encourage uptake of risk-minimising behaviours.

A Brief Educational Intervention Increases Knowledge of the Sugar Content of Foods and Drinks but Does Not Decrease Intakes in Scottish Children Aged 10-12 Years

OBJECTIVE

To assess the effectiveness of an educational intervention to improve children's knowledge of the sugar content of food and beverages.

METHODS

Cluster-randomized, controlled trial with 268 children (aged 10-12 years) from 14 primary schools in Aberdeen, Scotland. The intervention group received 2 interactive classroom sessions about sugar. A questionnaire to assess knowledge was completed at baseline and 4, 10, and 34 weeks postintervention. Dietary intake was assessed by food frequency questionnaire at baseline and on weeks 10 and 34.

RESULTS

After the intervention, the intervention group demonstrated greater knowledge of sugar than did the control group (P < .001), which was sustained at week 34 (P < .001). Dietary intakes of sugar did not change postintervention. Pre-intervention children underestimated the sugar content of fruit-based beverages.

CONCLUSIONS AND IMPLICATIONS

Children's knowledge of sugar in food and beverages is limited but can be improved through a simple educational intervention. Further intervention would be needed to encourage a change in dietary intake.

Prevention of dental erosion of a sports drink by nano-sized hydroxyapatite in situ study

AIM

To evaluate the inhibitory effects of the sports drink containing nano-sized hydroxyapatite (nano-HA) on dental erosion in situ.

DESIGN

The study had a single-blind, two-treatment crossover design. The two treatment groups were a control group (CG; Powerade only) and an experimental group (EG; 0.25% wt/vol nano-HA was added to Powerade). Ten subjects wore removable palatal appliances containing bovine enamel specimens. The appliances were immersed in each drink for 10 mins, 4 times a day for 10 days. The tooth surface microhardness (SMH) was tested, and the erosion depth and the morphology of the tooth surface were observed. The data were analysed by repeated measures anova and t-test.

RESULTS

Between the baseline and the 10th day, SMH was decreased by 80% in the specimens of the CG (P < 0.001), whereas there was only a 6% decrease in the SMH of the specimens in the EG. An erosion depth of 12.70 ± 4.66 μm and an irregular tooth surface were observed on the 10th day in the specimens of the CG. No dental erosions, however, was observed in the specimens of the EG.

CONCLUSIONS

The sports drink containing 0.25% nano-HA was effective in preventing dental erosion in situ.

Atomic force microscopic comparison of remineralization with casein-phosphopeptide amorphous calcium phosphate paste, acidulated phosphate fluoride gel and iron supplement in primary and permanent teeth: An in-vitro study

Context:

Demineralization of tooth by erosion is caused by frequent contact between the tooth surface and acids present in soft drinks.

Aim:

The present study objective was to evaluate the remineralization potential of casein-phosphopeptide-amorphous calcium phosphate (CPP-ACP) paste, 1.23% acidulated phosphate fluoride (APF) gel and iron supplement on dental erosion by soft drinks in human primary and permanent enamel using atomic force microscopy (AFM).

Materials and Methods:

Specimens were made from extracted 15 primary and 15 permanent teeth which were randomly divided into three treatment groups: CPP-ACP paste, APF gel and iron supplement. AFM was used for baseline readings followed by demineralization and remineralization cycle.

Results and Statistics:

Almost all group of samples showed remineralization that is a reduction in surface roughness which was higher with CPP-ACP paste. Statistical analysis was performed using by one-way ANOVA and Mann-Whitney U-test with P < 0.05.

Conclusions:

It can be concluded that the application of CPP-ACP paste is effective on preventing dental erosion from soft drinks.

Using written vignettes in focus groups among older adults to discuss oral health as a sensitive topic

When the mouth yields pain and distress, it can impact psychosocially the lives of older adults and might constitute a sensitive topic for open disclosure. In this article, we describe our use of a written vignette in focus groups for discussion of oral health and disablement. Six focus groups were conducted with 42 older men and women with an average age of 75 years who were purposefully selected through advertisements posted in community centers and retirement homes. In discussions lasting for an average of 90 min, groups of up to 9 participants commented positively and negatively on the vignette's story and voluntarily discussed their personal experiences, family histories, and testimonies about the mouth and coping and adapting strategies to disabilities. The discussion about oral health can be sensitive, but the vignette shifted the focus away from the participants and allowed them to share personal experiences with oral health and disablement.

Oral health research with children

BACKGROUND

There has been a shift towards research with children and the adoption of the concept of child-centred research. However, the majority of oral health research is conducted on children, rather than with them.

OBJECTIVE

This study aimed to provide an overview of contemporary approaches to research with children.

CONSIDERATIONS

The methodological considerations of such research include: the power relationship between the adult researcher and the child participant, with important factors of language use, the setting for the research, appropriate analysis, and quality of the data; ethical factors such as the purpose and risks of the research, confidentiality, recruitment, funding, information to children and parents, consent, and dissemination; and appropriate methods. Methods suitable for oral health research with children include quantitative techniques such as questionnaires and qualitative approaches including interviews individually or in groups and participatory techniques such as time-lines/life grids, drawings, and vignettes.

CONCLUSION

There is considerable scope to access children's perspectives of their oral health and care through actively involving them in research. To conduct such research, however, requires training or collaboration with colleagues from other disciplines.