Integrating Oral Health into Health Professions School Curricula

Implementation and Effectiveness of a Nurse-Led Oral Hygiene Program for Schoolchildren: A Quasi-Experimental Study

OBJECTIVES

Good oral hygiene is essential for schoolchildren's well-being. However, lack of knowledge, negative attitudes, and poor oral hygiene practices may predispose to oral-related diseases. This study aimed to examine the effectiveness of a nurse-led oral hygiene program on schoolchildren's knowledge, attitudes, and practices.

DESIGN

A quasi-experimental design with pre-and-post-test was used.

SAMPLE

Using the convenience sampling technique, we recruited 400 schoolchildren, aged 11-12 and in grades 5-6, from two primary schools in Egypt.

METHODS

The study was conducted from September 2022 to May 2023. The Oral Hygiene Program served as the primary intervention. This program contains health education topics (e.g., the importance of oral hygiene, techniques for effective tooth brushing, and dietary choices that promote dental health). Three visits were conducted (Visit 1: introduction of the program purpose and objectives and pre-test scores collection, Visit 2: implementation of oral hygiene topics, and Visit 3: post-test scores collection). We used three self-report instruments (Oral Health Knowledge Questionnaire, Hiroshima University's Dental Behavioral Inventory, and Oral Health Practice Questionnaire) for pre- and post-test. Paired T test and Pearson correlation analysis were used for data analysis.

RESULTS

After the intervention program, the oral hygiene program effectively enhanced schoolchildren's knowledge, attitudes, and practices. The post-intervention mean scores were 7.83 ± 0.488 (knowledge), 6.63 ± 1.7 (practices), and 9.33 ± 1.1 (attitudes). High statistically significant differences were noted between schoolchildren's oral health knowledge, attitudes, and practices before and after implementing the program (p = 0.000).

CONCLUSION

There were enhancements in the level of knowledge, with improved positive attitudes and satisfactory practices among schoolchildren after the implementation of the oral hygiene program. Integrating oral hygiene programs into the general curriculum in primary schools and training school nurses, caregivers, and teachers in implementing oral hygiene programs could improve oral health knowledge, attitudes, and practices for preventing oral problems.

Effects of Self-Perceived Oral Health and Stress Levels on Subjective Oral Symptoms and Lifestyle of University Students in South Korea: A Cross-Sectional Survey

Background

Self-perceived oral health is related to clinical and subjective oral factors, socioeconomic factors, perceived stress, and oral health behavior. However, limited studies have examined whether self-perceived oral health is related to dry mouth, salivary viscosity, or lifestyle factors. Accordingly, this study aimed to verify the effect of self-perceived oral health and stress levels on subjective oral symptoms and lifestyle.

Methods

The responses of 644 university students who agreed to participate in the study were analyzed. A chi-square test was used to determine whether self-perceived oral health and stress levels showed significant differences based on subjective oral symptoms and lifestyle. Logistic regression was used to analyze the effect of subjective oral symptoms and periodontal disease diagnosis on self-perceived oral health.

Results

Subjective oral symptom factors that showed significant differences depending on self-perceived oral health included gingival bleeding or pain, dry mouth, and saliva viscosity, and depending on lifestyle factors included the frequency of tooth brushing and beverage consumption. Additionally, subjective oral symptoms influenced self-perceived oral health. Self-perceived oral health was negative when there was gingival bleeding, pain (odds ratio (OR)=0.594, p=0.002), and dry mouth (OR=0.577, p=0.001).

Conclusions

This study's results showed that self-perceived oral health significantly impacts gingival bleeding, pain, and dry mouth. Therefore, government intervention must provide and manage innovative and efficient education programs that promote self-perceived oral health management habits and maintenance and improvement of oral health.

Oral Health Knowledge, Attitudes, and Learned Clinical Skills in Pediatric Medicine Residents and Nurse Practitioner Students: A Pre-Post Design

(1) Background/Objective: California has one of the highest rates of pediatric dental caries in the nation. One way to combat this problem is through non-dental provider training programs that focus on prevention. However, there are limited data on healthcare provider training program integration and evaluation of oral health curricula focused on prevention of early childhood caries. This study will assess the change in healthcare providers' attitudes, knowledge, and skills by implementing an interprofessional educational (IPE) oral health curriculum in medicine and nurse practitioner programs at one university in Southern California. (2) Methods: A mixed method design was employed using a pre- and post-educational survey, and end-of-program focus group interviews. Descriptive statistics and paired t-tests were used to assess group differences and thematic analyses for the focus groups. (3) Results: A total of 81 students (14 pediatric medicine residents, 18 pediatric, and 49 family nurse practitioners) completed the curriculum and surveys. Attitudes related to oral hygiene remained unchanged, with the nurse practitioner group showing improved clinical skills (all questions; p < 0.021). Knowledge scores significantly improved across all groups (paired t-test; p < 0.001). All focus groups expressed the helpfulness of the educational modules, the usefulness of the skills learned, and the benefits of IPE activities. (4) Conclusion: Healthcare providers showed improved oral health knowledge and clinical skills acquired through the oral health program and can serve as a model to educate across disciplines on the prevention of early childhood caries.

Adoption of New Oral Health Interventions in Primary Care: Qualitative Findings

Introduction

This is the first study to use the Common-Sense Model of Self-Regulation theory for oral health interventions in pediatric practices. The objective of this qualitative study was to assess adoption and implementation of theory-based multilevel oral health interventions, by clinicians (pediatricians and nurse practitioners) participating in a cluster randomized clinical trial, to create an oral health toolkit for widespread dissemination into pediatric practices.

Methods

Semistructured interviews were conducted at the conclusion of the cluster randomized clinical trial with 21 clinicians from 9 practices participating in the intervention arm. Clinicians in this arm received Common-Sense Model of Self-Regulation theory-based education and resources to deliver oral health interventions to parents/caregivers and document in electronic medical record. Semistructured interview questions were based on the Diffusion of Innovations Theory, assessing adoption and implementation. The interviews were coded using NVivo (QRS International) software. Main themes were identified using a thematic analysis approach.

Results

Five themes identified from the interviews included strengths of theory-based oral health training for clinicians, oral health resources to improve quality of care, considerations for efficient future implementation, financial considerations, and parent benefits and challenges. Clinicians found that the theory-based training and resources increased knowledge and confidence when addressing oral health with parents and required only ≤2 minutes in their workflow with no financial consequences. Clinicians reported an increase in oral health awareness among parents but suggested an overall need for more pediatric dentists.

Conclusions

The Common-Sense Model of Self-Regulation theory-based education and resources were well received by clinicians and perceived to be beneficial without adverse impact on workflow or practice finances. An online toolkit is planned because these oral health interventions can be successfully implemented and delivered in medical settings.

Needs analysis for an undergraduate dental curriculum in KPK, Pakistan: Gap identification and general needs assessment

Objective

Dental institutes continue to face challenges in making the transition from a discipline-based to an integrated curriculum. The need analysis is often the first step in the development and implementation of any curriculum. This study intends to carry out a needs analysis for a contemporary dental curriculum in private and public sector dental colleges of Peshawar, KPK, Pakistan.

Methods

The mixed method study was carried out at public and private dental institutes in Peshawar from April to July 2022. To guarantee triangulation, data were gathered from three sources. The first source was an analysis of the Pakistan Medical and Dental Council's dental curriculum accreditation standards. The second source was gathering the experts' perspectives, and the final source was a systematic literature search to explore the necessity for an integrated undergraduate dental curriculum from the experiences and expertise of contemporary curricula.

Results

Thematic analysis identified the need for the dental curriculum to be a five-year BDS program, involvement of students, and inclusion of digital dentistry and environmental sustainability in the dental curriculum. PMDC accreditation standards focus on alignment in mission, vision, curricular outcomes, an integrated curriculum, and a quality assurance system for assessment. Experts identified the need for a patient-centered curriculum focusing on integrated patient care. They also identified that the current educational environment should be improved to sustain a contemporary dental curriculum in Pakistan. For the literature review, nine articles were included in the final review.

Conclusion

The current dental curriculum is not accommodating to the needs of the students in Peshawar. The current dental education environment lacks the infrastructure, logistics, and teacher training to sustain the standards set by PMDC.

Current scientific evidence for why periodontitis should be included in diabetes management

This Perspective provides a brief summary of the scientific evidence for the two-way links between periodontal diseases and hyperglycemia (diabetes mellitus [DM] and pre-DM). It delivers in a nutshell current scientific evidence for manifestations of hyperglycemia on periodontal health status and effects of periodontal diseases on blood glucose levels and in turn incidence, progression, and complications of diabetes. Of outmost importance is presentation of scientific evidence for the potential of routine periodontal treatment to lower blood glucose levels, providing a novel, economical tool in DM management. Non-surgical periodontal treatment ("deep cleaning") can be provided by dental hygienists or dentists in general dental offices, although severe cases should be referred to specialists. Such therapy can decrease the costs of DM care and other health care costs for people with DM. The great importance of a healthy oral cavity free of infection and subsequent inflammation - especially periodontitis that if untreated will cause loosening and eventually loss of affected teeth - has largely gone unnoticed by the medical community as the health care curricula are largely void of content regarding the bi-directional links between oral health and systemic health, despite elevation of blood glucose levels being an integral part of the general systemic inflammation response. The importance of keeping disease-free, natural teeth for proper biting and chewing, smiling, self-esteem, and pain avoidance cannot be overestimated. Medical and dental professionals are strongly encouraged to collaborate in patient-centered care for their mutual patients with - or at risk for - hyperglycemia.

Claims analysis of Medicare fee-for-service oral health care encounters, from 2019 through 2021

BACKGROUND

Many qualifying people rely on Medicare fee-for-service (FFS) for their health care insurance, although it rarely provides coverage for oral health care services. The objective of this study was to gain insights into oral health care that is being provided by all health care provider types for Medicare FFS beneficiaries.

METHODS

The authors used the Centers for Medicare & Medicaid Services Virtual Data Research Center to query 100% of Medicare FFS claims from 2019 through 2021 and identify all encounters for which there was either an oral health-related International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis code or a CDT 2019-2021: Current Dental Terminology code recorded on the claim. The authors used a cross-sectional study design and calculated descriptive statistics to describe characteristics of identified oral health care encounters. The encounter level was the unit of analysis.

RESULTS

A total of 2,098,056 oral health care encounters were identified through Medicare FFS claims during the study observation period, with a lower volume observed after 2019. Nearly 98% of encounters were related to those in which oral health diagnoses were recorded (International Classification of Diseases, Tenth Revision, Clinical Modification code on claim), and non-oral health care providers primarily submitted these claims. Most encounters included beneficiaries with chronic conditions, and a roughly equal proportion included those qualifying for Medicare on the basis of age and disability.

CONCLUSIONS

Previously unreported characteristics of oral health care encounters were identified through administrative claims, providing insights into oral health care being provided to a subset of Medicare FFS beneficiaries.

PRACTICAL IMPLICATIONS

Future research and policies should focus on strengthening medical-dental integration models and expanding access to oral health care for the Medicare FFS population.

Putting the Mouth Into the Head-to-Toe Assessment: Nursing Oral Health Assessment Training With an Oral Health Therapist

BACKGROUND

Oral care is one of the most neglected nursing practices, lacking oral care protocols, efficient training, and awareness of the benefits for clients. In particular, there is a gap in research for nursing oral health assessment training for nursing curricula.

METHOD

This study explored the effects of interprofessional collaboration (IPC) training between nurses and oral health therapists (OHT) using newly developed oral health assessment tools with an aim of reducing barriers for nursing oral health assessment. The self-efficacy and confidence of nursing students in oral health assessment were evaluated using pre- and posttraining surveys, and a focus group.

RESULTS

Nursing students' confidence in incorporating oral health assessment into head-to-toe assessment improved after training.

CONCLUSION

Nursing oral health assessment training with IPC, onsite OHT support, and oral health assessment tools improved the confidence and attitudes of nursing students in oral health assessment and care provision. [J Nurs Educ. 2023;62(7):399-402.].

Australian nursing students' perception, knowledge, and attitude towards oral healthcare of older people and associated factors: a national cross-sectional survey

BACKGROUND

The oral health of many older Australians is poor and associated with many systemic health problems. However, nurses often have a limited understanding of the importance of oral healthcare for older people. This study aimed to investigate Australian nursing students' perception, knowledge, and attitude toward providing oral healthcare for older people and associated factors.

METHODS

A cross-sectional study was conducted among final year nursing students studying at accredited nursing programs using an online self-reported 49-item survey. The data were analysed using univariate and bivariate analysis (t-test, ANOVA, Spearman's correlation test).

RESULTS

A total of 416 final-year nursing students from 16 accredited programs in Australia completed the survey. Mean scores showed that more than half of the participants felt they lacked confidence (55%, n = 229) and had limited knowledge about oral healthcare for older people (73%, n = 304); however, their attitude towards providing such care was favourable (89%, n = 369). A positive correlation was found between students' confidence in delivering oral healthcare to older people and their perceived knowledge (r = 0.13, p < 0.01). Results revealed a statistically significant positive association between students' experience in providing oral healthcare to older people and students' perception (t = 4.52, p < 0.001), knowledge (t = 2.87, p < 0.01), and attitude (t = 2.65, p < 0.01) mean scores in such care. Nearly 60% (n = 242) of participants received education/training in oral healthcare for older people at university, but this was often for less than one hour. Around 56% (n = 233) believed that the current nursing curriculum did not prepare them to provide effective oral healthcare to older people.

CONCLUSION

Findings suggested a need for nursing curricula to be revised to include oral health education and clinical experience. Knowledge of evidence-based oral healthcare by nursing students may improve the quality of oral healthcare for older people.

Oral health literacy and its associated factors among nurses: A cross-sectional study

AIMS AND OBJECTIVES

To investigate the oral health literacy (OHL) of nurses and explore the factors affecting their OHL.

BACKGROUND

OHL is important for improving the oral health outcomes. Nurses' OHL may affect the oral health of themselves, families, and patients. Few studies have examined the OHL and its related factors among nurses.

DESIGN

A cross-sectional design following the STROBE guideline.

METHODS

A total of 449 nurses were recruited from tertiary hospitals in the minority areas of southwest China. The participants completed an online questionnaire, which contained questions related to the OHL, sociodemographic factors, general health, oral health and related behaviours, oral health knowledge, attitudes, and oral health-related quality of life. OHL was measured using the validated Chinese version of the short-form Health Literacy of Dentistry (HeLD-14) scale. Descriptive statistics, the Mann-Whitney U test, Spearman's correlation, and multiple linear regression analysis were used to analyse the data.

RESULTS

The median HeLD-14 score (p25-p75) was 50.0 (44.0-54.0). The regression model for OHL was found to be significant. The factors that influenced OHL included oral health knowledge, oral health attitudes, self-reported oral health, annual household income, and dental flossing; these factors accounted for 13.9% of the variance in OHL.

CONCLUSIONS

The nurse' OHL has room for improvement. Nurses' OHL could be improved by enriching their oral health knowledge, promoting their positive oral health attitudes, increasing their household income, and helping them build correct oral health behaviours.

RELEVANCE TO CLINICAL PRACTICE

The findings of the study could be used to make a case for changing nursing curricula. Oral health knowledge curriculum or programmes targeted towards nurses should be developed to improve their OHL.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Student stress and mental health during online learning: Potential for post-COVID-19 school curriculum development

This article aims to analyze the trend of publications on student stress and mental health topics during online learning as well as the potential for post-COVID-19 curriculum development. 1456 articles were analyzed by the bibliometric method. Data were obtained from the Scopus database consisting of 1382 articles, 73 review articles, 1 conference article. Based on the analysis, Li X is the most productive author with 16 documents, while in terms of the number of citations, Wang C ranks first with 3897 citations. Meanwhile the most frequently used keywords were COVID-19 (n = 862), followed by stress (n = 312), mental health (n = 260), anxiety (n = 248), and depression (n = 214). These represent the trend of publications related to the topics discussed in 2020. Moreover, alternative research themes such as online learning, higher education, sleep, loneliness, perceived stress, insomnia, emotional intelligence, and psychological resilience can be further investigated in the future. This article recommends developing a curriculum that can accommodate various issues during COVID-19 and the changing learning climate after the pandemic. The potential for post-COVID-19 school curriculum development is also discussed.

Dental Bite-Sized Bits: A Module for Teaching Common Oral Health Conditions to Multidisciplinary Students

The Surgeon General's report in the year 2000 highlighted the association between chronic diseases and oral health infections. Current healthcare education programs, regrettably, report only 1 to 3 h of oral health instruction within curricula. In the years 2020-2022, as part of their respective oral health curricula, 278 first-year physician assistant and 12 pre-clinical second-year pharmacy students were invited to participate in a voluntary survey examining the effectiveness of animated succinct, online video-based oral health units. Among all student responses for the post-use survey, respondents "strongly agreed" or "agreed" that learning objectives of the unit(s) were achieved after reviewing the videos. Of the participants, 97% "strongly agreed" or "agreed" that the videos helped them understand information of which they had no prior knowledge. Similarly, 98% "strongly agreed" or "agreed" the information was appropriate for their level of knowledge. Most students, 93%, "strongly agreed" or "agreed" the exercise was a valuable learning experience. Regarding the importance of future interprofessional collaboration pertaining to a mutual patient's oral health, 95% of participants "strongly agreed" or "agreed" that they would be likely to collaborate. This study demonstrates the importance of oral health as a critical area of focus in healthcare education. The study also confirms the hypothesis that Dental Bite-Sized Bits units deliver engaging, valuable oral health education for preclinical healthcare learners, incorporating interprofessional perspectives from the disciplines of dental, pharmacy, and physician assistant.

An interprofessional school-based initiative to increase access to oral health care in underserved Florida counties

OBJECTIVE

To examine and describe the effect of an oral health education program on school-based nurses' acquisition of oral health knowledge.

METHODS

Three-hour synchronous videoconference sessions provided training for nurses to conduct oral health risk assessments, screen for oral diseases, deliver oral health education, apply fluoride varnish, and refer children identified in need of further assessment and treatment to a dentist. Oral health knowledge acquisition was assessed by comparing pre-training and post-training examination scores. Analyses included descriptive statistics and the Wilcoxon signed-rank test.

RESULTS

Seventeen nurses from Suwannee, Lafayette, and Hamilton counties participated in the oral health education training program. Analyses of the school-based nurses' test results showed a significant increase in correct answers on the post-training test (93%) compared to the pre-training test (56%). Six hundred forty-one children from six elementary public schools received oral health education, oral screenings, and fluoride varnish applications. Fifty-eight percent of the children had untreated caries, 43% had treated caries, 15% had sealant on permanent molars, and 3% required urgent care. Nurses successfully referred children identified in need of further assessment and treatment to a dentist.

CONCLUSIONS

The synchronous videoconference oral health training program was effective in improving school-based nurses' oral health knowledge. The knowledge acquired by school-based nurses via oral health training programs can be leveraged to increase access to oral health care for vulnerable and unserved school-aged populations.

Assessing Risks of Early Childhood Caries in Primary Care Practice Using Electronic Health Records and Neighborhood Data

CONTEXT

Early childhood caries (ECC) is a persistent public health challenge, affecting more than 56% of US toddlers and preschool-aged children. Despite this, ECC is largely preventable with routine oral hygiene practices, diet, and application of topical fluoride.

OBJECTIVE

This study assessed the utilization of preventive oral health care in primary care practices and evaluated the variation in patient characteristic and geographic disparities.

DESIGN

We conducted a retrospective study using electronic health records (EHRs) over a 2-year period. Patients' home addresses were geocoded and linked to census-based neighborhood statistics and fluoridated water accessibility. Multiple logistic regression modeling was used to assess the risk of ECC in patients with fluoride preventive care, controlled for demographics, comorbid conditions, and neighborhood risk factors.

PARTICIPANTS

Patients aged 6 to 71 months who had primary care providers at family medicine and general pediatric clinics in a large academic medical center.

MAIN OUTCOME MEASURE

The presence of dental caries based on diagnoses in EHRs.

RESULTS

The study consisted of 10 836 patients: 17% treated with topical fluoride varnish (TFV), 12% prescribed oral fluoride supplement, 6.1% with both TFV and supplement, and 64% without fluoride treatment. Patients with fluoride treatment were 24% to 53% less likely to have ECC. Children living in rural and nonfluoridated water communities had 1.7 to 1.8 times greater risk of developing ECC. Minority, under/uninsured, and low-income patients also were at an increased risk of ECC.

CONCLUSION

Despite continuing efforts to improve access to dental care for vulnerable populations, substantial disparities remain among socioeconomically disadvantaged children. To address dental care shortage, primary care clinicians should serve as the safety net to care for vulnerable and underserved children who have no or limited access to oral health services. Future research into the collaboration between primary care and dental providers at the level of both practice and professional education should be considered.