Psychosocial correlates of oral hygiene behaviour in people aged 9 to 19 – a systematic review with meta‐analysis

Finding the person behind caries disease: The dental caregivers' experiences of empowering patients to implement beneficial behavioral changes

OBJECTIVES

This study aimed to elucidate dental professionals' experiences of how to empower patients at risk of developing new or additional caries to promote caries-related preventive behavioral changes.

METHODS

Semi-structured in-depth interviews were conducted, audio-recorded, transcribed verbatim, and subjected to qualitative content analysis. To provide credibility and high-quality data, participant recruitment followed strategic sampling. The 10 participants included nine women and one man; six participants were dentists, and four were dental hygienists. In the data analysis, five descriptive and five strategic themes emerged that formed an overarching theme: Finding the person behind caries disease.

RESULTS

The results indicated that by initially getting to know the person behind the patient, trusting relationships and knowledge can be generated to successfully influence patients' behaviors related to caries. The five descriptive themes included: Building a treatment alliance, Understanding habitual patterns, Motivating for changes, Implementing new behaviors, and Preserving behavioral improvements. The descriptive themes each revealed a strategy theme containing several strategy proposals for initiating and supporting caries-preventing behavioral changes.

CONCLUSIONS

This study highlights the importance of establishing a treatment alliance to improve the patient's skills, knowledge, and motivation. It underscores the significance of recognizing the individual behind the patient, to facilitate optimal behavior change at the lowest possible level of treatment.

CLINICAL SIGNIFICANCE

Our findings could assist in strengthening caries-related health promotion, caries prevention, and understanding of oral health literacy techniques.

Effect of patients' attitude and perception of oral hygiene on white spot lesion development and plaque accumulation during orthodontic treatment : A survey of patients with fixed appliances

PURPOSE

To explore the impact of oral hygiene practices, as well as beliefs and attitudes toward orthodontic treatment on white spot lesion (WSL) development and plaque accumulation in orthodontic patients.

MATERIALS AND METHODS

A total of 106 individuals (61 female, 45 male) patients aged 10-49 years who were treated with fixed appliances treatment completed a 14-question survey regarding aspects of their oral hygiene (OH) and orthodontic visits. The number of teeth with WSL and the plaque indexes were recorded for each patient. Poisson regression and linear regression models were used to analyze the association of survey responses with the observed WSLs and plaque accumulation, respectively.

RESULTS

Participants of both sexes reported similar beliefs about OH (66% agreed to the importance of OH statements), practiced proper OH (69% good practices), and reported a similar perception regarding the quality of their OH routine and of their orthodontic treatment. However, in total, none of the findings was significantly related to the development of WSLs or plaque accumulation. Significantly fewer WSLs were observed in male patients who perceived themselves as having good control over OH. Female participants reported significantly higher expectations regarding posttreatment smile improvement compared to males. Overall, responses by male participants were deemed to be more accurate than those by female participants when related to WSL development and plaque accumulation.

CONCLUSION

Our survey hints at a possible relationship between WSL formation and patients' sense of control over OH routine in males. Future studies should further explore the effect of sex on the attitude toward and perception of OH in orthodontic patients. This survey highlights the multifactorial nature of WSL development in orthodontic patients and the complexity of predicting patient compliance.

Oral hygiene practices and associated factors among rural communities in northwest Ethiopia

BACKGROUND

Poor oral hygiene affects the overall health and quality of life. However, the oral hygiene practice in rural communities and contributing factors are not well documented. Accordingly, this study was conducted to assess oral hygiene practices and associated factors among rural communities in northwest Ethiopia.

METHODS

A cross-sectional study was conducted among 1190 households. Data were collected using a structured and pretested questionnaire, prepared based on a review of relevant literature. The questionnaire comprises socio-demographic information, access to health and hygiene messages, oral hygiene practices, and water quality. We assessed oral hygiene practices with these criteria: mouth wash with clean water in every morning, mouth wash with clean water after eating, brushing teeth regularly, and avoiding gum pricking. Gum pricking in this study is defined as sticking needles or wires into gums to make the gums black for beauty. Multivariable logistic regression was used to identify factors associated with oral hygiene practices. Significant associations were declared on the basis of adjusted odds ratio with 95% confidence interval and p-values < 0.05.

RESULTS

Results showed that all the family members usually washed their mouth with clean water in everyday morning and after eating in 65.2% and 49.6% of the households, respectively. Furthermore, 29.9% of the households reported that all the family members regularly brushed their teeth using toothbrush sticks and one or more of the family members in 14.5% of the households had gum pricking. Overall, 42.9% (95% CI: 39.9, 45.6%) of the households had good oral hygiene practices. Health and/or hygiene education was associated with good oral hygiene practices in the area (AOR: 1.66, 95% CI: 1.26, 2.21).

CONCLUSION

More than half of the households had poor oral hygiene practices in the area and cleaning of teeth with toothpastes is not practiced in the area, where as gum pricking is practiced in more than one-tenth of the households. The local health department needs provide community-level oral health education/interventions, such as washing mouth with clean water at least twice a day, teeth brushing using indigenous methods such as toothbrush sticks or modern methods such as toothpastes, and avoiding gum pricking to promote oral health.

Mobile app for comprehensive management of orthodontic patients with fixed appliances : Design and use

OBJECTIVES

This study aimed to design and implement a mobile phone application (app) aiming to enhance the cooperation and oral hygiene of orthodontic patients.

METHODS

An orthodontic app named "Labkhand" was designed by a team of orthodontists and programmers according to the needs and scheduled interventions for patients. The aim of this app was to obviate the orthodontic needs of patients by providing educational content in the form of texts and videos, oral hygiene reminders, appointment reminders, and nutrition reminders. It also enabled instant messaging and chatting between patients and dental personnel. In this study, 61 patients were monitored during their orthodontic treatment procedure. All patients were evaluated using a questionnaire with 7 questions before and after a 6-month treatment period. A total of 31 patients were instructed to use the app, while the other 30 patients received treatment without the app. The collected data were analyzed using paired t‑test and analysis of covariance (ANCOVA) test.

RESULTS

While the control group's questionnaire score remained almost the same (P > 0.05), the mean questionnaire score of patients in the intervention group significantly increased after using the app compared to the baseline scores acquired before using the app (P < 0.001). The greatest improvement was noted in topics related to "reminding of appointments", "general information about orthodontic treatment", and "oral hygiene maintenance and instructions". "Quality of services" and "patient-orthodontist communication" showed the least improvement in patient satisfaction.

CONCLUSIONS

The Labkhand orthodontic app has multiple functions and can obviate the needs of orthodontic patients easily and at a low cost.

Sense of coherence moderates the relationship between perceived racial discrimination and oral health-related quality of life in schoolchildren

AIM

To evaluate the moderating effect of the sense of coherence (SOC) in the relationship between racial discrimination and oral health-related quality of life (OHRQoL) in schoolchildren.

METHODS

This is a cross-sectional study nested in a cohort performed in southern Brazil. OHRQoL was assessed using the short version of the Child Perceptions Questionnaire 11-14 (CPQ11-14). The perception of racial discrimination was measured using a question contained in the Bullying Questionnaire by Olweus, and SOC through the shortened version of the 13-item Sense of Coherence Scale. Sociodemographic and dental caries following the International Caries Detection and Assessment System (ICDAS) characteristics were also collected. A simple slop test and Poisson regression analysis were performed to test the interaction effects of the predictors on OHRQoL.

RESULTS

A total of 429 schoolchildren were included in this study. About 6.7% reported had perceived racial discrimination. The simple slope test indicated that the negative effects of racial discrimination on OHRQoL were significant under different SOC levels. Among schoolchildren who suffered racial discrimination, those who had higher SOC reported lower impact on OHRQoL when compared to those with low SOC.

CONCLUSION

SOC can be considered a moderating variable in the relationship between racial discrimination and OHRQoL.

CLINICAL SIGNIFICANCE

These findings highlight that psychosocial factors such as SOC could attenuate the impact of perceived discrimination on OHRQoL in adolescence.

Theory-based behavioral change interventions to improve periodontal health

Periodontal disease is a significant global health burden affecting half of the world's population. Given that plaque and inflammation control are essential to the attainment of periodontal health, recent trends in preventive dentistry have focused on the use of behavioral models to understand patient psychology and promote self-care and treatment compliance. In addition to their uses in classifying, explaining and predicting oral hygiene practices, behavioral models have been adopted in the design of oral hygiene interventions from individual to population levels. Despite the growing focus on behavioral modification in dentistry, the currently available evidence in the field of periodontology is scarce, and interventions have primarily measured changes in patient beliefs or performance in oral hygiene behaviors. Few studies have measured their impact on clinical outcomes, such as plaque levels, gingival bleeding and periodontal pocket reduction, which serve as indicators of the patient's disease status and quality of oral self-care. The present narrative review aims to summarize selected literature on the use of behavioral models to improve periodontal outcomes. A search was performed on existing behavioral models used to guide dental interventions to identify their use in interventions measuring periodontal parameters. The main models were identified and subsequently grouped by their underlying theoretical area of focus: patient beliefs (health belief model and cognitive behavioral principles); stages of readiness to change (precaution adoption process model and transtheoretical model); planning behavioral change (health action process approach model, theory of planned behavior and client self-care commitment model); and self-monitoring (self-regulation theory). Key constructs of each model and the findings of associated interventions were described. The COM-B model, a newer behavioral change system that has been increasingly used to guide interventions and policy changes, is discussed with reference to its use in oral health settings. Within the limitations of the available evidence, interventions addressing patient beliefs, motivation, intention and self-regulation could lead to improved outcomes in periodontal health. Direct comparisons between interventions could not be made due to differences in protocol design, research populations and follow-up periods. The conclusions of this review assist clinicians with implementing psychological interventions for oral hygiene promotion and highlight the need for additional studies on the clinical effects of behavioral model-based interventions.

Racial and ethnic disparities in periodontal health among adults seeking dental care in rural North Carolina communities: A retrospective study

BACKGROUND

Population studies consistently demonstrate a greater prevalence of chronic diseases, including oral diseases, among underrepresented minorities. This retrospective study aimed to measure and describe the prevalence and extent of periodontitis among adults seeking dental care within an academic practice-based network in rural North Carolina.

METHODS

This study used de-identified electronic health record (EHR) data from 2011 to 2017 of adult dentate patients (aged ≥30 years) seeking dental care who received a comprehensive periodontal examination at one of nine networked clinical centers. Periodontitis prevalence was calculated using CDC/AAP case definitions, along with extent (%) scores for periodontal parameters. Comparisons focused on age, sex, race, ethnicity, tobacco use, diabetes status, payer or insurance status, plaque scores, and the number of teeth.

RESULTS

EHR data for 10,544 adult patients (60.5% female) indicated 79.8% had some form of periodontitis. This patient population was diverse: 22.6% Black, 4.4% American Indian, and 53.8% White, with 4.8% self-identified as Hispanic. Patients 50 years and older showed greater mean extent scores for clinical attachment levels relative to patients 30 to 49 years. Males exhibited greater periodontitis than females (p = 0.001). Blacks showed significantly (p < 0.001) greater periodontitis prevalence relative to Whites. Hispanics also showed a greater prevalence of periodontitis (p < 0.001) relative to non-Hispanics. Significantly greater periodontitis was also noted for tobacco users (p < 0.001) but not for diabetes or payer status. A multiple logistic regression analysis of periodontitis prevalence confirmed significant associations for periodontitis for age, sex, race, ethnicity, tobacco use, high plaque scores, and the number of teeth (p < 0.001), but not diabetes or payer status.

CONCLUSIONS

The data document that racial and ethnic inequalities in periodontal health occur within the population of adults residing in rural communities in North Carolina and seeking dental care.

Novel behavioral model in evaluating initiation and sustenance of teeth brushing behavior among students pursuing health sciences: a cross-sectional study

Background: Oral hygiene maintenance is a crucial and integral feature in determining the overall wellbeing of a person. It has been established that interventions for health promotion at the public health level derived from theoretical models based on social and behavioural sciences have a superior effectiveness as compared to the ones without a theoretical background. Hence a novel behavioral model known as the multi-theory model (MTM) was used to understand two important aspects of health behavior change: (i) Initiation and (ii) Sustenance in twice daily teeth brushing in a university setting with objectives to identify factors effecting MTM in initiation and sustenance of twice daily brushing behavior among students pursuing health sciences and correlating the MTM theory with socio-demographic and behavioral patterns.

Methods: The study is an analytical cross-sectional study. Students pursuing Medicine and Dentistry in a University setting were included. A validated questionnaire was designed for this study. Questions were framed to evaluate the constructs of initiation and sustenance of MTM, personality, sleeping habits and demographic corelates of participants. Multiple means between the groups were compared using analysis of variance and a post hoc test. Correlation was established between different domains, the items were then entered for hierarchical multiple regression.

Results: Of the 235 participants in the study, 229 completed the questionnaire. There was a significant association between brushing quartiles, professional streams (p<0.001) and academic performance (p<0.001). The hierarchical multiple regression revealed that at stage one, behavioral confidence contributed significantly to the regression model (F (1,227) = 33.227, p<0.001) and accounted for 12.4% of the variation in twice daily brushing.

Conclusion: MTM is a good tool in predicting the initiation and sustenance of twice daily brushing behavior among young adults and can form a useful tool in assessing the patterns of brushing behavior in a population.

Modeling the theory of planned behavior to predict adults' intentions to improve oral health behaviors

Background

The present study aimed to apply the theory of planned behavior (TPB) to identify predictors of adults’ intentions to improve oral health behaviors.

Methods

This cross-sectional study was conducted with 1,328 adults living in the Jeddah city, Saudi Arabia. A 64-item questionnaire that evaluated behavioral intention, oral health knowledge (OHK) and TPB constructs (attitudes, perceived behavioral control, and subjective norms) was distributed. Descriptive statistics and structural equation modeling (SEM) were used to describe the data and examine the associations among the variables. A p-value of < 0.05 was considered significant.

Results

The analysis revealed that the TPB model explained 72% of the variance in oral health behavioral intentions (OHBI), indicating a good model fit. The TPB constructs of attitudes (β = 0.299), subjective norms (β = 0.035), and perceived behavioral control (β = 0.144) were significant predictors of OHBI, whereas OHK was not. Attitude was the strongest predictor of intentions to improve oral health behaviors.

Conclusions

The findings suggest that this model could be a helpful framework for designing oral health promotion and intervention programs. Such programs should focus on changing adults’ attitudes, positive influences from close relationships, and improving self-efficacy of OHB to improve their oral health behavior.

Effectiveness of an online application of the health action process approach (HAPA) theory on oral hygiene intervention in young adults with fixed orthodontic appliances: a randomized controlled trial

Background

This randomized controlled trial aimed to evaluate the effectiveness of an online application based on HAPA theory on oral hygiene promotion in young adults with fixed orthodontic appliances.

Methods

A WeChat mini-program (called “Clean Teeth”) based on HAPA theory was designed beforehand to improve oral-health behaviors and oral hygiene, and 44 participants aged 17–29 with fixed orthodontic appliances were recruited. Participants of the experimental group (n = 22) received the “Clean Teeth” mini-program, in addition to care as usual, and the control group (n = 22) only received routine oral health education. Data were collected during three orthodontic check-ups: baseline (T0), 6 weeks of follow-up (T1), and 12 weeks of follow-up (T2). All participants completed questionnaires assessing oral health behaviors and the psychosocial factors of the HAPA model and accepted the clinical examinations involving the dental plaque index and the gingival bleeding index.

Results

After a 12-week intervention, the plaque index and gingival bleeding index in the experimental group were significantly lower than that in the control group. The psycho-social parameters of social effects, expected outcomes, and action control were improved significantly after treatment, among which social effects increased significantly only in the experimental group but not in the control group.

Conclusions

The HAPA theory-based mini-program had positive effects on oral-health behavior promotion and oral hygiene among young adults with fixed orthodontic appliances.

Trial registration This study was retrospectively registered in the Chinese Clinical Trial Registry, with the number CTR2200056731, dated 12/02/2022. http://www.chictr.org.cn/index.aspx.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02219-w.

Relationship between sense of coherence and health-related behaviours in adolescents and young adults: a systematic review

Background

The sense of coherence is developed through the learning process and contributes to the positioning of individuals in the health-disease continuum, facilitating successful and adaptive personal outcomes. Health-related behaviours represent a health determinant of utmost importance for public health and the development of adolescent and youth health promotion policies, as they are related to the main risk factors and problems of morbidity and mortality in our society. Previous studies have analysed the relationship between sense of coherence and only some individual health outcomes such as oral health, the relationship of sense of coherence with smoking and alcohol consumption, concluding that salutogenic factors are related to quality of life and preventive behaviours. The aim of this systematic review was to describe the relationship of sense of coherence with different health-related behaviours investigated so far in the adolescent and youth population.

Methods

A systematic review was carried out in databases (PubMed, CINAHL, Scopus and PsycInfo) and in the bibliographies of the retrieved articles, without limitation of time or language. Associations between sense of coherence and health-related behaviours have been assessed.

Results

A total of 1214 investigations were reviewed and 21 of them were included in this systematic review. The relationship between sense of coherence and eight health-related behaviours were identified (alcohol use, physical activity, tobacco use, eating habits, rest periods, use of illegal substances, behaviours related to oral health and time spent in games on the computer).

Conclusions

Our results increase the available evidence and support the solid relationship of the sense of coherence with health behaviours both as a protective factor against risk behaviours and for its positive association with preventive and health promoting behaviours of adolescents, young adults and university students.

Does the Efficacy of Behavior Management Techniques Differ Between Children From Single-Child and Multi-Child Families?: A Quasi-Experimental Study

Aim

Behavior management techniques (BMTs) efficiently deliver dental treatment to children with dental anxiety. The objective of this quasi-experimental study was to examine whether the efficacy of BMTs applied for the improvement of compliance in pediatric patients differs between children 3–10-year-olds from single-child and multi-child families.

Materials and Methods

In this quasi-experimental, 197 caregiver-child couples were divided into two groups: single-child group (116 couples) and multi-child group (81 couples). Children's pre- and post-treatment anxiety levels were measured by facial mood scale (FMS) and Frankl Behavior Rating Scale (FBRS), respectively.

Caregivers' dental anxiety was measured by the Chinese version of the Modified Dental Anxiety Scale (MDAS), which was included in the self-designed questionnaire. Data were analyzed by using the Mann-Whitney U-test, chi-square tests, and binary multivariate regression analysis.

Results

There was no statistically significant difference in the demographic characteristics of the children between the two groups. BMTs were found to be capable of reducing children's dental anxiety (CDA): the compliance rate was 45.69–88.79% in the single-child group and 44.44–85.79% in the multi-child group pre- and post-BMTs, but there was no significant difference in the change of compliance between the two groups (p > 0.05). In the subgroup analysis, parenting style (odds ratio [OR] = 0.054, p < 0.05) and father's education (OR = 8.19, p < 0.05) affected the varies of children's compliance in the single-child group. In contrast, in the multi-child group, gender (OR = 8.004, p < 0.05) and mother's occupation (OR = 0.017, p < 0.05) were associated with these changes in compliance.

Conclusions

In this study, BMTs were proved to be beneficial in improving compliance in 3- to 10-year-olds children in dental treatment. Though there was no significant difference in the change of compliance between children from single-child and multi-child families, different associated factors may affect the two groups. Therefore, the related family factors should be taken into account when professionals manage each child's behavior in dental practice.

Relationship between dental experiences, oral hygiene education and self-reported oral hygiene behaviour

Many preventive approaches in dentistry aim to improve oral health through behavioural instruction or intervention concerning oral health behaviour. However, it is still unknown which factors have the highest impact on oral health behaviours, such as toothbrushing or regular dental check-ups. Various external and internal individual factors such as education, experience with dentists or influence by parents could be relevant. Therefore, the present observational study investigated the influence of these factors on self-reported oral heath behaviour. One hundred and seventy participants completed standardized questionnaires about dental anxiety (Dental Anxiety Scale (DAS), and dental self-efficacy perceptions (dSEP)). They also answered newly composed questionnaires on oral hygiene behaviours and attitudes, current and childhood dental experiences as well as parental oral hygiene education and care. Four independent factors, namely attitude towards oral hygiene, attitude towards one's teeth, sense of care and self-inspection of one's teeth were extracted from these questionnaires by rotating factor analysis. The results of the questionnaires were correlated by means of linear regressions. Dental anxiety was related to current negative emotions when visiting a dentist and negative dental-related experiences during childhood. High DAS scores, infantile and current negative experiences showed significant negative correlations with the attitude towards oral hygiene and one's teeth. Dental anxiety and current negative dental experiences reduced participants' dental self-efficacy perceptions as well as the self-inspection of one's teeth. While parental care positively influenced the attitude towards one's teeth, dental self-efficacy perceptions significantly correlated with attitude towards oral hygiene, self-inspection of one's teeth and parental care. Dental anxiety, dental experiences, parents' care for their children's oral hygiene and dental self-efficacy perceptions influence the attitude towards oral hygiene and one's own oral cavity as well as the autonomous control of one's own dental health. Therefore, oral hygiene instruction and the development of patient-centred preventive approaches should consider these factors.

Perspectives on Social and Environmental Determinants of Oral Health

Most oral conditions have a multifactorial etiology; that is, they are modulated by biological, social, economic, cultural, and environmental factors. A consistent body of evidence has demonstrated the great burden of dental caries and periodontal disease in individuals from low socioeconomic strata. Oral health habits and access to care are influenced by the social determinants of health. Hence, the delivery of health promotion strategies at the population level has shown a great impact on reducing the prevalence of oral diseases. More recently, a growing discussion about the relationship between the environment, climate change, and oral health has been set in place. Certainly, outlining plans to address oral health inequities is not an easy task. It will demand political will, comprehensive funding of health services, and initiatives to reduce inequalities. This paper sought to give a perspective about the role of social and physical environmental factors on oral health conditions while discussing how the manuscripts published in this Special Issue could increase our knowledge of the topic.

Validation of self-reported oral health among Indonesian adolescents

Background and aim

With the recognition of health as a subjective state, self-reported oral health has been applied in many epidemiological studies. However, the validity of self-reports may vary across different age groups and socio-cultural backgrounds and by using different tools. This study aimed to assess the validity of self-reported oral health of 15-year-old Indonesian adolescents.

Materials and methods

This study used data from the Indonesian National Oral Health Survey, a part of the Indonesian Basic Health Survey 2018. The study included 572 15-year-old Indonesian adolescents. We compared the presence of clinically assessed dental caries, tooth loss, and fillings following the World Health Organization Basic Health Survey method and questionnaire-based self-reported oral conditions using McNemar test. The sensitivity (Sn), specificity (Sp), and likelihood ratios (LRs) of self-reports were calculated using clinical assessment as the reference standard. The overall accuracy of self-reports in identifying the clinical condition was assessed using the area under the curve (AUC) of a receiver operating characteristic curve.

Results

Self-reports significantly underestimated the clinical presence of caries (39.3% and 67.1%) and overestimated the clinical presence of tooth loss (9.3% and 4.2%) and filling (4.7% and 2.4%, p < 0.05). All self-reported conditions had higher Sp (at least 70.3%) than Sn (max 54.2%) and the AUC for all self-reported conditions were < 0.7. Self-reporting the presence of fillings had the highest LR+  = 11.

Conclusions

Self-reporting oral health in Indonesian adolescents had low accuracy. Further studies of other methods of self-reporting are needed before they can be used to assess adolescents’ oral health in epidemiological surveys.

Development of a secondary school-based digital behaviour change intervention to improve tooth brushing

BACKGROUND

Dental caries in adolescents remains a significant public health problem with few oral health promotion interventions aimed at reducing dental caries in secondary school-aged students. Previous oral health and mobile health (mHealth) research has suggested the need for the development of a school-based behaviour change intervention incorporating a digital component. This study aimed to describe the development process of a behaviour change intervention to improve the oral health of students aged 11-16 years attending secondary schools in the UK.

METHODS

A six-step process was used to develop the complex intervention informed by behaviour change theory and involving students, young people, parents and teachers in the process. The steps were: (1) identifying the target behaviours, namely tooth brushing with a fluoride toothpaste (2) identifying the theoretical basis and developing the causal model (3) reviewing the relevant literature and developing the logic model (4) designing the intervention with young people, parents and school staff (5) specifying the intervention content and (6) translating this content into features of the intervention and piloting.

RESULTS

The resultant intervention included a quality-assured classroom-based session (CBS) (guided by a lesson plan and teaching resources), delivered by school teachers which was embedded within the school curriculum. This CBS was followed by a series of (Short Message Service) SMS texts delivered twice daily to student's mobile telephones with the content, duration and timing of the messages informed by involvement of students and young people.

CONCLUSIONS

An intervention to improve the oral health of secondary school students through improved tooth brushing was rigorously developed based on behaviour change theory and work with young people, parents and school staff. Further research is needed to evaluate the outcomes and processes involved following the delivery of this intervention. BRIGHT Trial Trial Registration ISRCTN12139369.

Toothbrushing and related factors among high school students in the Southeast of Iran: A cross-sectional study

INTRODUCTION

Dental caries is one of the most common problems in student, and tooth brushing at least twice a day is one of the preventive measures of dental caries. This study aimed to determine the frequency of daily brushing and its related factors among high school students in the southeast of Iran based on the Health Action Process Approach (HAPA).

METHODS

In this cross-sectional study, 2045 high school students of 13-15 years from urban areas of Zahedan in the southeast of Iran with multistage random sampling were selected. A self-administered questionnaire was used to assess demographic background, psychosocial constructs of the HAPA and daily brushing frequency. Binary logistic regression analysis was performed to determine predictors of daily brushing.

RESULTS

Only 18% of participants reported tooth brushing at least twice a day, which is the desired brushing behaviour. Multivariate regression showed that increased odds of daily brushing associated with gender (OR = 2.38, 95% CI 1.84-3.08), mother education (OR = 2.27, 95% CI 1.62-3.18), father job (OR = 2.24, 95% CI 1.20-4.19), task self-efficacy (OR = 1.24, 95% CI 1.08-1.42), action planning (OR = 1.10, 95% CI 1.02-1.19) and maintenance self-efficacy (OR = 1.20, 95% CI 1.13- 1.27).

CONCLUSION

The brushing behaviour of students needs to be taken seriously in Zahedan. Motivational and volitional constructs of the HAPA include task self-efficacy, action planning, and maintenance self-efficacy could be considered in intervention programmes targeting increase adolescent brushing.

Social-cognitive predictors of parental supervised toothbrushing: An application of the health action process approach

BACKGROUND

We examined the social cognition determinants of parental supervised toothbrushing guided by the health action process approach (HAPA).

METHODS

In a prospective correlational survey study, participants (N = 185, 84.3% women) completed HAPA social cognition constructs at an initial time point (T1), and 12 weeks later (T2) self-reported on their parental supervised toothbrushing behaviour, toothbrushing habit, and action control.

RESULTS

Structural equation models exhibited adequate fit with the data when past behaviour and habit were either excluded or included. Intention, self-efficacy, planning, and action control were predictors of parental supervised toothbrushing; intention predicted action planning and coping planning; and self-efficacy and attitude were predictors of intention. Indirect effects of social cognition constructs through intentions, and intentions through planning constructs were also observed. Inclusion of past behaviour and habit attenuated model effects.

CONCLUSION

Results indicate that parental supervised toothbrushing is a function of motivational and volitional processes. This knowledge can be used to inform behaviour change interventions targeting parental supervised toothbrushing.

Modelling health belief predictors of oral health and dental anxiety among adolescents based on the Health Belief Model: a cross-sectional study

Background

A vicious cycle exists between dental anxiety, oral health behaviors and oral health status. Based on previous research, psychological factors of the Health Belief Model (HBM) are associated with oral health behaviors and oral health, and are likely involved in this cycle. However, little is known about the relationship between HBM factors and dental anxiety of adolescents. The purpose of this cross-sectional study was to investigate the relationship between health belief factors, oral health and dental anxiety based on the constructs of the HBM.

Methods

1207 Grade 2 students from 12 secondary schools in Hong Kong were randomly selected and measured for the decayed, missing and filled permanent teeth (DMFT) index. Data for oral health behaviors, HBM constructs and dental anxiety were collected using questionnaires. The hierarchical entry of explanatory variables into logistic regression models estimating prevalence odds ratios (POR) were analyzed and 95% confidence intervals (95% CI) for DMFT and dental anxiety were generated. Path analysis was used to evaluate the appropriateness of the HBM as predictors for oral health behaviors, DMFT and dental anxiety.

Results

Based on the full model analysis, individuals with higher perceived susceptibility of oral diseases (POR: 1.33, 95% CI: 1.14–1.56) or girls or whose mother received higher education level were likelier to have a DMFT≥1, while those with higher perceived severity (POR: 1.31, 95%CI: 1.09–1.57), flossing weekly, DMFT≥1 or higher general anxiety level statistically increases the possibility of dental anxiety. The results from path analysis indicated that stronger perceived susceptibility, greater severity of oral diseases, less performing of oral health behaviors and a higher score of DMFT were directly related to increased dental anxiety level. Other HBM variables, such as perceived susceptibility, self-efficacy beliefs, cues to action and perceived barriers, might influence dental anxiety through oral health behaviors and caries status.

Conclusions

Clarifying the propositional structures of the HBM may help the future design of theory-based interventions in reducing dental anxiety and preventing dental caries.

Supplementary Information

Supplementary information accompanies this paper at 10.1186/s12889-020-09784-1.

Parental social-cognitive correlates of preschoolers' oral hygiene behavior: A systematic review and meta-analysis

BACKGROUND

Regular and consistent parental involvement in children's oral hygiene practices is crucial to prevent oral diseases in young children. This emphasizes the need for interventions targeting parental-supervised oral hygiene behavior. To inform the design of future interventions, this meta-analysis aimed to identify the parental social-cognitive factors associated with oral hygiene behavior of preschoolers.

METHOD

Five bibliographic databases were searched. A study was eligible for inclusion when it reported an association between a parental social-cognitive factor and an oral hygiene behavior in the targeted age cohort. Meta-analyses were performed when there were at least four independent effect sizes (k > 3).

RESULTS

Of the 5945 records identified, 25 studies contained eligible data to be included in four meta-analyses: attitude (k = 12); self-efficacy (k = 12); intention (k = 6), and sense of coherence (k = 5). The results showed that greater frequency of preschoolers' oral hygiene behavior is significantly associated with parental attitudes (r⁺ = 0.18), self-efficacy (r⁺ = 0.34), and intention (r⁺ = 0.29), and not significantly associated with parental sense of coherence (r⁺ = 0.08).

CONCLUSION

Self-efficacy, attitudes, and intention were identified as significant correlates of parental-supervised oral hygiene behavior. However, this is a limited evidence base and many social-cognitive factors, such as self-regulatory processes including planning and action control, have yet to be explored in this context. The significant social-cognitive correlates identified in this study, as well as potential other self-regulatory factors, should be targeted in future intervention studies aimed at improving this important preventive behavior.

The application of theory-guided oral health interventions in adolescents: a systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

To explore theory-guided randomized controlled trials aimed at improving adolescents' oral health and evaluate their effectiveness.

DESIGN

Multiple library databases with search criteria for articles between 1990 and 2019.

MAIN OUTCOME MEASURES

Searched references were coded and screened for theory-guided interventions for adolescent oral health. Characteristics of each study (study sample, adopted theory, outcome measures, length of follow-up and main findings) were extracted and the quality of the eligible trials assessed. Effect sizes for theory-guided interventions for different follow-up periods were analysed and compared with traditional oral health education.

RESULTS

About 2135 results were uncovered, 64 were extracted for further screening, and 10 studies were eligible for inclusion. For plaque presence outcomes, no statistical difference was observed between theory-guided interventions and traditional interventions at 3 months (MD: -5.94, 95% CI: -16.39 to 4.51). When the duration of observation was extended to over one year, a significant reduction was found (SMD: -0.25, 95% CI: -0.46 to -0.04).

CONCLUSION

Theory-guided interventions for improving oral hygiene status appear to be more effective than traditional interventions for adolescents in the long term. However, more comprehensive studies are required for validation to support the implementation and adoption of these programs in the clinical setting.

Building a new scale to measure worries about oral hygiene self-management in vulnerable older adults

OBJECTIVE

This paper describes a new scale to measure worries about self-management of oral hygiene in low-income older adults.

BACKGROUND

Oral hygiene that prevents oral diseases and worsening of chronic conditions improves with instruction, but other cognitive/emotional factors impede oral hygiene practice especially among older adults. Many scales measure dental anxiety, but none measures oral hygiene self-management worries.

MATERIALS AND METHODS

Formative research with diverse older adults 55-95 in low-income housing identified scale items. A 23-item scale was tested in a pilot intervention study (n = 84) and formalised with a new sample (N = 331).

RESULTS

In both studies, PCA/factor analysis produced two subscales: (a) worries about cleaning teeth and (b) consequences of cleaning. Chronbach's alpha coefficient evaluated internal consistency, and Pearson's r and Kendall tau/Spearman's rho evaluated scale predictability, convergent and divergent validity. The scale and subscales showed good internal consistency in both studies (over 0.90) and stability T0 0.90; T1: 0.90). In the larger sample, statistically significant correlations between the scale, subscales; plaque score, and similar scales (perceived risk of oral health problems, and fears of oral diseases) demonstrated convergent validity. For divergent validity, the worries scale, not the GOHAI, a similar scale measuring oral health life quality, was associated with Plaque Score. Each scale was associated with different mediators suggesting different constructs.

CONCLUSION

The overall scale has good internal consistency, test-retest reliability, predictability and convergent and divergent validity. It captures a psycho-emotional construct useful in oral health research and hygiene education with older adults.

Parenting stress as a mediator in the oral health of children and adolescents: A stress process model

OBJECTIVES

We tested hypotheses regarding socioeconomic status (SES) disparities in oral health amongst children and adolescents and the extent to which such SES disparities may be mediated by parenting stress.

METHODS

We analysed data from the 2011/2012 US National Survey of Children's Health for ages 6-11 years (n = 21 596) and 12-17 years (n = 23 584). Our models estimated associations between SES indicators (family income and parental education) and parenting stress with two oral health outcomes: parent-reported child oral health and preventive dental visits.

RESULTS

For both age groups, SES was positively associated with both oral health outcomes. Parenting stress mediated the relationship between SES and child oral health, not preventive dental visits-such that lower SES was associated with worse oral health via higher parenting stress. Amongst children, the indirect effect of parenting stress was observed for parental education and family income, whilst amongst adolescents, no indirect effect of parenting stress was observed.

CONCLUSION

Parenting stress was an important determinant of children's oral health and partially explained the SES-related oral health disparities in children. Future research is needed to explore the causal pathways in this association.

Self-regulation in oral hygiene behaviours in adults with gingivitis: The mediating role of coping planning and action control

AIM

This study investigates the joint role of volitional predictors of oral hygiene behaviours of flossing and brushing in adults with gingivitis, framed by the Health Action Process Approach model (HAPA).

MATERIALS AND METHODS

In a longitudinal online survey, 201 participants aged 18-75, of which 56.7% were women, completed assessments at baseline(T1), 2 weeks(T2) and 4 months(T3). Oral hygiene behaviours(OH) (brushing and flossing) and social cognitive determinants of behaviour in the HAPA: action and maintenance self-efficacy(ASE & MSE), intention(INT), coping planning(CP) and action control(AC) were evaluated. Structural equation modelling was used to test a series of three nested models. In Model 1, action self-efficacy would determine MSE and INT, and INT would determine OH; in Model 2, INT would determine both CP and AC and the two OH behaviours; and in Model 3, CP and AC would be sequential mediators between INT and OH.

RESULTS

Model 3, predicting a mediating process from intention to behaviour via coping planning and action control, showed the best fit according to the fit indices and explained more of the variance in dental hygiene. The mediating role of coping planning and action control between intention and oral hygiene behaviours was thus confirmed. Importantly, coping planning did not mediate between intention and oral hygiene behaviours, which means that oral hygiene intention influences action control through coping planning, and both sequentially mediate this influence on behaviour.

CONCLUSIONS

For individuals who are not yet following the recommendations for specific oral hygiene behaviours, coping planning and action control represent psychological mechanisms by which intentions are put into practice.

Effect of the sense of coherence and associated factors in the quality of life of head and neck cancer patients

The sense of coherence (SOC) is a measure of global orientation regarding the ability of individuals to cope with stressful situations. The aim of the present study was to evaluate the association between SOC and quality of life (QoL) and clinical and sociodemographic characteristics among survivors of oral, oropharynx, hypopharynx, or larynx cancer. A cross-sectional study was conducted with 90 cancer patients in follow up at the Santa Maria University Hospital in southern Brazil who had completed conformal 3D radiotherapy at least three months earlier. QoL was assessed using the University of Washington Quality of Life (UW-QOL) questionnaire and SOC was measured using the Brazilian version of the SOC-13 questionnaire. Data on socio-demographic characteristics and the disease were obtained from patients' charts. Oral clinical conditions were also evaluated. Associations between exploratory variables and mean UW-QOL scores were evaluated through Poisson regression and the results were presented as rate ratios (RR) and 95% confidence intervals (CI). The mean overall UW-QOL score was 67.90 (± 18.71). Moderate and high SOC scores were associated with higher mean UW-QOL scores, that is, individuals with a stronger SOC demonstrated better QoL, (p < 0.05). Regarding the clinical variables, individuals with advanced stage cancer and those with hyposalivation and trismus had poorer QoL (p < 0.05). Patients with a greater SOC reported a better quality of life. Our findings show the importance of focusing on psychosocial factors, which can alleviate the impact caused by the disease and improve the QoL of these patients.

Factors associated with the number of filled teeth in adolescents from public schools: a cohort study

This study aimed to assess the association of demographic conditions, socioeconomic status, clinical variables, and psychosocial factors with the number of filled teeth in adolescents from public schools. This cohort study comprised 1,134 12-year-old adolescents enrolled in public schools in Santa Maria, Brazil, in 2012. They were followed-up in 2014, where 743 individuals were reassessed (follow-up rate of 65.52%) for the number of filled teeth. Data were collected via dental examinations and structured interviews. Demographic and socioeconomic characteristics were collected from parents or legal guardians. The psychosocial factor comprised students' subjective measurement of happiness (Brazilian version of the Subjective Happiness Scale - SHS). Dental examinations were performed to assess the number of filled teeth through decay, missing, and filled teeth index (DMF-T). Unadjusted and adjusted Poisson regression analyses were performed to assess the association between baseline variables and filled teeth at follow-up. The number of filled teeth in 2012 and 2014 were 193 (17.02%) and 235 (31.63%), respectively. The incidence of filled teeth in 2014 was 42 (5.65%). Adolescents with untreated dental caries, those who visited the dentist in the last 6 months, those that exhibited being happier, and those who had filled teeth at baseline were associated with a higher number of filled teeth at follow-up. We conclude that the number of filled teeth in adolescents was influenced by clinical and psychosocial factors, emphasizing the need to focus on oral health policies in individuals with higher disease burden and those who feel psychologically inferior.

Modeling the Theory of Planned Behaviour to predict adherence to preventive dental visits in preschool children

Objectives

Dental caries is the most common chronic childhood disease that occurs in a continuum and can be prevented by children and their parents’ adherence to recommended oral health behaviors. Theory-driven tools help practitioners to identify the causes for poor adherence and develop effective interventions. This study examined the Expanded Theory of Planned Behaviour (TPB) Model by adding the concept of Sense of Coherence (SOC) to predict parental adherence to preschooler’s preventive dental visits.

Methods

Data regarding socio-economic demographics were collected from parents of children aged 2–6 years. Constructs of TPB including parental attitudes, subjective norms (SN), Perceived Behavioural Control (PBC), and intention to attend preventive dental visits for their preschoolers were collected by questionnaire, alongside parents’ sense of coherence (SOC). Dental attendance was measured by asking if the child had a regular dental visit during the last year. Structural Equation Modeling Analysis (SEMA) was carried out to identify significant direct and indirect (mediated) pathways in the extended TPB model.

Results

Three hundred and seventy-eight mothers (mean age = 34.41 years, range 22–48) participated in the study. The mean age of children was 3.92 years, range: 2–6), and 75.9% had dental insurance. Results of the final model showed that predisposing factors (child’s birthplace and mother’s birthplace) significantly predicted enabling resources (family monthly income and child’s dental insurance status); both predicted the TPB components (PBC, SN, and attitude). TPB components, in turn, predicted behavioural intention. However, contrary to expectation, intention did not significantly predict dental attendance in the past 12 months. Parent’s SOC significantly predicted TPB components and dental attendance. Overall, 56% of the variance in dental attendance was explained by the expanded TPB model.

Conclusions

The expanded TPB model explained a great deal of variance in preschooler’s dental attendance. These findings suggest that the expanded model could be used as the framework for designing interventions or strategies to enhance dental attendance among preschoolers; in particular, such strategies should focus specifically on enhancing parental SOC including empowerment.

A theory-based intervention delivered by an online social media platform to promote oral health among Iranian adolescents: a cluster randomized controlled trial

Objective: Based on the Health Action Process Approach, we tested the efficacy of a theory-based program using an online social media platform (Telegram) to promote good oral hygiene behaviour among Iranian adolescents.Design: A three-arm randomized-controlled trial design was used, consisting of an adolescent only intervention group (A group; n = 253), an adolescent and mother intervention group (A + M group; n = 260), and a control group (n = 278).Main outcome measures: Psychosocial variables, toothbrushing behaviour, Visual Plaque Index, and Community Periodontal Index.Results: Increases in adolescent toothbrushing at the one- and six-month follow-ups in both intervention groups compared to the control group were observed. Adolescents in the A + M group showed significant greater improvements in their toothbrushing behaviour, Visual Plaque Index, and Community Periodontal Index scores than adolescents in the A group. Improvements to toothbrushing social cognitions were also observed.Conclusions: Current results support the use of the theory-based program delivered by Telegram in improving good oral hygiene behaviour and oral health outcomes among Iranian adolescents. Involving mothers in an intervention can confer additional benefits for adolescent oral health.

The effect of using a mobile application ("WhiteTeeth") on improving oral hygiene: A randomized controlled trial

Objective

To evaluate the effectiveness of the WhiteTeeth mobile app, a theory‐based mobile health (mHealth) program for promoting oral hygiene in adolescent orthodontic patients.

Methods

In this parallel randomized controlled trial, the data of 132 adolescents were collected during three orthodontic check‐ups: at baseline (T0), at 6‐week follow‐up (T1) and at 12‐week follow‐up (T2). The intervention group was given access to the WhiteTeeth app in addition to usual care (n = 67). The control group received usual care only (n = 65). The oral hygiene outcomes were the presence and the amount of dental plaque (Al‐Anezi and Harradine plaque index), and the total number of sites with gingival bleeding (Bleeding on Marginal Probing Index). Oral health behaviour and its psychosocial factors were measured through a digital questionnaire. We performed linear mixed‐model analyses to determine the intervention effects.

Results

At 6‐week follow‐up, the intervention led to a significant decrease in gingival bleeding (B = −3.74; 95% CI −6.84 to −0.65) and an increase in the use of fluoride mouth rinse (B = 1.93; 95% CI 0.36 to 3.50). At 12‐week follow‐up, dental plaque accumulation (B = −11.32; 95% CI −20.57 to −2.07) and the number of sites covered with plaque (B = −6.77; 95% CI −11.67 to −1.87) had been reduced significantly more in the intervention group than in the control group.

Conclusions

The results show that adolescents with fixed orthodontic appliances can be helped to improve their oral hygiene when usual care is combined with a mobile app that provides oral health education and automatic coaching. Netherlands Trial Registry Identifier: NTR6206: 20 February 2017.

The DIKW pathway: a route to effective oral health promotion?

A large portion of oral health education is carried out by dental care professionals in general dental practice. Awareness that the giving of advice or facts relating to oral disease is unlikely to change behaviour in itself should be a determining factor in the content and delivery of health messages. Recognising the mechanism whereby messages may be translated into actions is fundamental to constructing an oral health plan for patients. The DIKW pathway (data-information-knowledge-wisdom) is an easily understood concept which can be applied alongside, or in place of, more technical behavioural or socio-environmental models to inform the composition of oral health education delivery. This model can be applied also to other areas of communication in the dental setting, including enabling patient decision-making and giving consent. Developed for business information systems and analysts, it suggests a pathway from giving and receiving advice, through to action based on personal contextual meanings and motivations which are perceived as wisdom.

Cross-cultural adaptation and psychometric properties of the Indonesia version of the self-efficacy oral health questionnaire for adolescents

BACKGROUND

Self-efficacy can be interpreted as a self-belief that one has successfully committed to a specific situation or maintained a specific behaviour.

AIM

We aimed to test the reliability and validity of a cross-cultural adaptation of the self-efficacy oral health (SEOH) questionnaire in the Indonesian language among adolescents and to understand the diverse perspectives of oral health self-efficacy related to gender.

DESIGN

A cross-cultural adaptation of the SEOH self-administered questionnaire was completed followed by a dental caries examination. Sample size estimation suggested 341 adolescents aged 12-13 years. Eleven junior high schools were clustered and randomly selected from six districts across Jakarta, Indonesia.

RESULTS

The SEOH was reliable with interclass correlation and Cronbach's alpha values of 0.86 and 0.86, respectively. Significant results for the construct and discriminant validity analyses were observed. There was no significant difference in terms of the total score between males and females, but there was a significant difference in terms of the psychology control domain.

CONCLUSIONS

Our study results provide evidence supporting the reliability and validity of the Indonesian version of the SEOH questionnaire for adolescents across Indonesia.

The role of psychological theories in oral health interventions: A systematic review and meta-analysis

OBJECTIVE

In the present study, we attempted to assess how psychological theories (health belief model [HBM], theory of planned behaviour [TPB], social cognitive theory [SCT], clinical theories [CT] and other theories [OT]) influence oral health interventions.

METHODS

PubMed, Scopus, Cochrane and Web of Knowledge databases from 2000 to 2017 were searched. We defined psychological theories based on five subgroups: (A) HBM, (B) TPB, (C) SCT, (E) CT and (F) OT.

RESULTS

From the 156 identified studies, 19 studies based on PICO were included. Our findings indicated that the standardized mean difference (SMD) of HBM was 0.37 (95% CI: 0.24, 0.51), which was statistically significant in improving oral health. The SMD of SCT was not significant (0.05 [95% CI: -0.33, 0.44]) in improving oral health. The SMD of TPB was significant (1.66 [95% CI: 1.06, 2.27]) in improving oral health. The SMD of CT (-4.6 [95% CI: -6.49, -2.71]) and OT (2.93 [95% CI: 1.55, 4.32]) revealed significant differences in improving oral health.

CONCLUSION

The current meta-analysis showed that in general, psychological interventions that used OT, CT, HBM and TPB were effective in enhancing oral health status, and interventions that used SCT did not have an effect on improving oral health status. Oral health care providers who work with patients to take methods and improve behaviours that are related to appropriate oral health need to comprehend their applicability and strengths.

The Association between Sense of Coherence and Dental Caries in Low Social Status Schoolchildren

The relationship between dental caries and sense of coherence (SOC) has not been substantiated in children and adolescents, particularly among those with a low socioeconomic status. The aim of this study was to investigate the association between SOC and dental caries in schoolchildren from a low socioeconomic background. A random sample of 356 8- to 14-year-old schoolchildren enrolled in public schools from the poorest region of Santa Maria, a southern city in Brazil, was selected. Dental examinations were performed to assess dental plaque and dental caries (DMF-S and dmf-s indexes). The children's SOC was assessed using a validated Brazilian version of the SOC-13 scale. Socioeconomic, demographic, and behavioral data were collected from parents using a questionnaire. Multilevel Poisson regression analysis was used following a hierarchical approach to investigate the association between the SOC and DMF-T + dmf-t mean. Children whose mothers had studied for 8 years or less (RR 1.30; 95% CI 1.08-1.57) and children with dental plaque (RR 1.29; 95% CI 1.06-1.58) presented with higher DMF-T scores than their counterparts (p < 0.05). A higher household income (RR 0.66; 95% CI 0.51-0.84) and greater SOC scores (RR 0.71, 95% CI 0.56-0.90) were associated with lower DMF-T in children (p < 0.05). Children's SOC seems to be a relevant protective psychosocial factor for dental caries experience in socially vulnerable children.

Exploring changes in oral hygiene behaviour in patients with diabetes and periodontal disease: A feasibility study

Objective

Exploring the feasibility to understand changes in oral hygiene behaviour using the Health Action Process Approach (HAPA) model applied to qualitative research interviews in patients with diabetes and periodontitis undergoing standard periodontitis treatment.

Methods

Patients with type 1/2 diabetes and chronic periodontitis (n = 8) received standard non‐surgical periodontal treatment accompanied with personalized oral hygiene instructions by a dental hygienist. Clinical indices (% bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL), % of sites with PD ≥ 5 mm, periodontal epithelial surface area (PESA) and periodontal inflammatory surface area (PISA) were recorded pre‐ and post‐treatment. At 3 months post‐treatment, patients were interviewed using a topic guide relating to oral health. A behaviour change framework was constructed from elements of the HAPA model and used directly to map interview data to evaluate oral hygiene behaviour in these patients.

Results

Data from this feasibility study suggest a clinical improvement in periodontal status, albeit only monitored for 3 months. Application of the HAPA model highlighted the behavioural change pathway that diabetes patients undertake before, during and after periodontal treatment. The data suggest that patients move through all elements of the motivation phase and all elements of the volition phase except for the recovery self‐efficacy element.

Conclusion

The novel approach of applying the HAPA model to qualitative research data allowed for the collection of richer data compared to quantitative analysis only. Findings suggest that, in general, patients with periodontitis and diabetes successfully manage to incorporate new oral hygiene behaviours into their daily routine.

A Mobile App (WhiteTeeth) to Promote Good Oral Health Behavior Among Dutch Adolescents with Fixed Orthodontic Appliances: Intervention Mapping Approach

Background

The insertion of fixed orthodontic appliances increases the risk of dental caries, particularly in adolescents. Caries can be prevented through good oral health behavior. To support adolescents with fixed orthodontic appliances and for promoting oral health behavior, we developed a theory- and evidence-based mHealth program, the WhiteTeeth app.

Objective

The objective of our paper was to describe the systematic development and content of the WhiteTeeth app.

Methods

For systematic development of the program, we used the intervention mapping (IM) approach. In this paper, we present the results of applying the first 5 steps of IM to the design of an mHealth program: (1) identifying target behaviors and determinants through problem analysis, including a literature search, a survey study, and semistructured interviews, to explore adolescent oral health behavior during orthodontic therapy; (2) defining program outcomes and objectives; (3) selecting theoretical methods and translating them into practical strategies for the program design; (4) producing the program, including a pilot test with 28 adolescents testing the acceptability and usability of the WhiteTeeth app; and (5) planning implementation and adoption.

Results

On the basis of our literature search, we identified fluoride use and control of dental plaque levels (eg, tooth brushing and proxy brush usage) as target behaviors for preventing caries. Next, we identified important and changeable determinants of oral health behavior that fitted the theoretical concepts of the Health Action Process Approach (HAPA) theory. The HAPA theory, the self-regulation theory, and the results of the semistructured interviews were used to define the program objectives, that is, the performance and change objectives. After defining the objectives, we identified multiple behavior change techniques that could be used to achieve these objectives, such as providing oral health information and feedback, prompting self-monitoring, coaching of set actions and coping plans, and sending reminders. We translated these methods into practical strategies, such as videos and a brushing timer. Next, we combined these strategies into a single program resulting in the WhiteTeeth app (which is available on both iTunes and Google Play stores as “Witgebit”). Adolescents with fixed orthodontic appliances and dental professionals were included in the development process to increase the success of implementation. The pilot test revealed that the app users appreciated and liked the app. The WhiteTeeth app can be integrated into current orthodontic care.

Conclusions

IM allowed us to identify multiple techniques that have been shown to be the most effective in initiating behavior change, but have not yet been incorporated into existing orthodontic apps. The WhiteTeeth app contains all these techniques, which makes it a unique and promising home-based app for promoting oral health in adolescents with fixed orthodontic appliances.

Protective psychosocial factors and dental caries in children and adolescents: a systematic review and meta-analysis

BACKGROUND

Psychosocial protective factors include dispositional and family attributes that may reduce the occurrence of dental caries.

AIM

This review analysed the evidence on the relationship between protective psychosocial factors and dental caries in children and adolescents.

DESIGN

Primary studies involving children and adolescents were searched in the following electronic databases: Medline, SCOPUS, LILACS, SciELO, and Web of Science. The reference lists were also screened. Protective psychosocial factor descriptors were in accordance with the salutogenic theory. The outcome was clinical measure of dental caries. Quality assessments were performed using the Newcastle-Ottawa scale.

RESULTS

The final search resulted in 35 studies, including 7 cohort, one case-control, and 27 cross-sectional studies. Most studies were of moderate quality. Meta-analyses revealed that low parental internal locus of control (cohort studies: OR = 1.42, 95% CI: 1.20-1.64; cross-sectional studies: OR = 1.30, 95% CI: 1.19-1.41), high parental external chance (OR = 1.20, 95% CI: 1.10-1.29), and high maternal sense of coherence (OR = 0.77, 95% CI: 0.62-0.93) were associated with dental caries in children. High social support (OR = 0.81, 95% CI: 0.68-0.93) and greater self-efficacy (OR = 1.50, 95% CI: 1.12-1.22) were also associated with dental caries in adolescents.

CONCLUSIONS

The current evidence suggests that some salutogenic factors are important protective factors of dental caries during childhood and adolescence.

Learning from good practice: a review of current oral health promotion materials for parents of young children

Objectives To examine the quality of UK-based oral health promotion materials (OHPM) for parents of young children aged 0-5 years old.Data sources OHPM were obtained via email request to dental public health consultants and oral health promotion teams in the UK, structured web-based searches or collected from oral health events.Data selection Materials were included if: they were freely available; they were in English; they were parent facing and included oral health advice aimed at children aged 0-5-years-old.Data extraction Quality assessment was based on: whether the oral health messages were consistent with Public Health England's Delivering better oral health guidance, and what barriers to good oral health were addressed by the OHPM using the Theoretical Domains Framework (TDF).Data synthesis A wide range of printed and digital OHPM were identified (n = 111). However, only one piece of material covered all 16 guidance points identified in Public Health England's Delivering better oral health (mean 6, SD 4), and one other material addressed all 12 domains of the TDF (mean 6, SD 2).Conclusions Although there were examples of high quality, further development is required to ensure OHPM are clear, consistent and address a wider range of barriers to good oral health behaviours.

Study protocol of a randomized controlled trial to test the effect of a smartphone application on oral-health behavior and oral hygiene in adolescents with fixed orthodontic appliances

BACKGROUND

Adolescents with fixed orthodontic appliances are at high risk of developing dental caries. To date, new smartphone technologies have seldom been used to support them in the preventive behavior that can help prevent dental caries. After an intervention-mapping process, we developed a smartphone application (the WhiteTeeth app) for preventing dental caries through improved oral-health behavior and oral hygiene. The app, which is intended to be used at home, will help adolescents with fixed orthodontic appliances perform their oral self-care behavior. The app is based on the Health Action Process Approach (HAPA) theory, and incorporates several behavior-change techniques that target the psychosocial factors of oral-health behavior. This article describes the protocol of a randomized controlled trial (RCT) to evaluate the effects of the WhiteTeeth app on oral-health behavior and oral-hygiene outcomes (presence of dental plaque and gingival bleeding) compared with those of care as usual, in patients aged 12-16 with fixed orthodontic appliances.

METHODS/DESIGN

The RCT has two conditions: an experimental group that will receive the WhiteTeeth app in addition to care as usual, and a control group that will only receive care as usual. Care as usual will include routine oral-health education and instruction at orthodontic check-ups. In the western part of the Netherlands 146 participants will be recruited from four orthodontic clinics. Data will be collected during three orthodontic check-ups: baseline (T0), 6 weeks of follow-up (T1) and 12 weeks of follow-up (T2). The primary study outcomes are the presence of dental plaque (measured with a modified Silness and Loë Plaque Index); and gingival bleeding (measured with the Bleeding on Marginal Probing Index). Secondary outcomes include changes in self-reported oral-health behaviors and its psychosocial factors identified by the HAPA theory, such as outcome expectancies, intention, action self-efficacy, coping planning and action control.

DISCUSSION

Since the intervention was designed to target psychosocial factors in the motivational and volitional components of the behavior-change process, we hypothesize that the app will cause greater improvements in oral-health behavior and oral hygiene more than traditional oral-health-promotion programs (i.e., care as usual).

TRIAL REGISTRATION

The trial has been registered with the Dutch Trial Register ( NTR6206 : 20 February 2017).

Parental supervision for their children's toothbrushing: Mediating effects of planning, self-efficacy, and action control

OBJECTIVES

With 60-90% of children worldwide reportedly experiencing dental caries, poor oral health in the younger years is a major public health issue. As parents are important to children's oral hygiene practices, we examined the key self-regulatory behaviours of parents for supervising their children's toothbrushing using the health action process approach.

DESIGN AND METHOD

Participants (N = 281, 197 mothers) comprised Australian parents of 2- to 5-year-olds. A longitudinal design was used to investigate the sequential mediation chain for the effect of intention (Time 1) on parental supervision for their youngest child's toothbrushing (Time 3), via self-efficacy and planning (Time 2), and action control (Time 3).

RESULTS

A latent-variable structural equation model, controlling for baseline behaviour and habit, revealed significant indirect effects from intention via self-efficacy and action control and intention via planning and action control, on parental supervision behaviour. The model was a good fit to the data, explaining 74% of the variance in parents' supervising behaviour for their children's toothbrushing.

CONCLUSION

While national recommendations are provided to guide parents in promoting good oral hygiene practices with their children, current results show the importance of going beyond simple knowledge transmission to support parents' intentions to supervise their children's toothbrushing actually materialize. Current findings make a significant contribution to the cumulative empirical evidence regarding self-regulatory components in health behaviour change and can inform intervention development to increase parents' participation in childhood oral hygiene practices, thus helping to curb rising oral health conditions and diseases. Statement of contribution What is already known on this subject? Self-regulatory skills are important to translate intentions into behaviour. Self-efficacy, planning, and action control are key self-regulatory skills for behaviour change. What does this study add? Self-regulatory skills are needed for parents to supervise their children's toothbrushings. Self-efficacy, planning, and action control are important self-regulatory skills in this context. Future interventions should map these self-regulatory predictors onto behaviour change techniques.

An application of the Health Action Process Approach model to oral hygiene behaviour and dental plaque in adolescents with fixed orthodontic appliances

BACKGROUND

The Health Action Process Approach (HAPA) model addresses health behaviours, but it has never been applied to model adolescents' oral hygiene behaviour during fixed orthodontic treatment.

AIM

This study aimed to apply the HAPA model to explain adolescents' oral hygiene behaviour and dental plaque during orthodontic treatment with fixed appliances.

METHODS

In this cross-sectional study, 116 adolescents with fixed appliances from an orthodontic clinic situated in Almere (the Netherlands) completed a questionnaire assessing oral health behaviours and the psychosocial factors of the HAPA model. Linear regression analyses were performed to examine the factors associated with dental plaque, toothbrushing, and the use of a proxy brush.

RESULTS

Stepwise regression analysis showed that lower amounts of plaque were significantly associated with higher frequency of the use of a proxy brush (R² = 45%), higher intention of the use of a proxy brush (R² = 5%), female gender (R² = 2%), and older age (R² = 2%). The multiple regression analyses revealed that higher action self-efficacy, intention, maintenance self-efficacy, and a higher education were significantly associated with the use of a proxy brush (R² = 45%).

CONCLUSION

Decreased levels of dental plaque are mainly associated with increased use of a proxy brush that is subsequently associated with a higher intention and self-efficacy to use the proxy brush.

Dental flossing and automaticity: a longitudinal moderated mediation analysis

We investigated the role of normative support, behavioural automaticity, and action control in predicting dental flossing behaviour. Between May and October 2015, 629 Australian young adults completed a questionnaire assessing constructs of normative support and automaticity, and a 2-week follow-up of dental flossing behaviour and action control, resulting in n = 241 persons for longitudinal analysis. Findings supported the hypotheses that the effect of normative support on behaviour would be mediated via automaticity, and the effect of automaticity would be moderated by action control. Current results extend previous research to elucidate the mechanisms that help to understand predictors of oral hygiene behaviours and contribute to the cumulative evidence concerning self-regulatory and automatic components of health behaviour.

Correlates of perceived stigma for people living with epilepsy: A meta-analysis

OBJECTIVE

Epilepsy, one of the most common, serious chronic neurological diseases, is accompanied by different levels of perceived stigma that affects people in almost all age groups. This stigma can negatively impact the physical and mental health of people living with epilepsy (PLWE). Good knowledge of perceived stigma for PLWE is important. In this study, we conducted a meta-analysis to identify the correlates of perceived stigma for PLWE.

METHODS

Studies on factors associated with perceived stigma for PLWE, including sociodemographic, psychosocial, and disease-related variables, were searched in PubMed, PsychINFO, EMBASE, and Web of Science.

RESULTS

Nineteen variables (k>1) were included in the meta-analysis. For sociodemographic characteristics, findings revealed that the significant weighted mean correlation (R) for "residence" and "poor financial status" were 0.177 and 0.286, respectively. For disease-related characteristics, all variables of significance, including "seizure severity," "seizure frequency," "number of medicines," and "adverse event" (R ranging from 0.190 to 0.362), were positively correlated with perceived stigma. For psychosocial characteristics, "depression" and "anxiety" with R values of 0.414 and 0.369 were significantly associated with perceived stigma. In addition, "social support," "quality of life (QOLIE-31,89)," "knowledge," and "attitude," with R values ranging from -0.444 to -0.200 indicating negative correlation with perceived stigma.

CONCLUSION

The current meta-analysis evaluated the correlates of perceived stigma for PLWE. Results can serve as a basis for policymakers and healthcare professionals for formulating health promotion and prevention strategies.