Rationale for the prevention of oral diseases in primary health care: an international collaborative study in oral health education

Propositions pour la prévention et la promotion de la santé bucco-dentaire chez les enfants

At the last congress of the Association Dentaire Française (ADF) (French Dental Association), the minister of health and prevention, François Braun, stressed the importance he attached to oral health prevention. He also emphasized his desire to roll out and extend prevention campaigns, targeting young people in particular. With this in mind, we are working to lay the political foundations for the mass, free distribution of single-use toothbrushes with fluoride toothpaste in schools. This oral health promotion campaign would aim to debunk any myths or misinformation spread by manufacturers and to encourage a profound cultural change in the way children and their parents learn about oral hygiene. The "cavity-score," which is still under development, could help to reinforce the idea, both among the general public and among healthcare professionals, that oral health is not isolated from the rest of the body, and that this health issue cannot be dealt with in isolation, but in conjunction with all healthcare professionals.

Primary Health Care Workforce in Southeast Asia Region, Existing Status and Strategies for Non-Communicable Diseases and Oral Health Alliance: A Scoping Review

Oral diseases and non-communicable diseases (NCD) share modifiable risk factors and common social determinants, thus creating new opportunities for improving oral health. The existing primary health care workers can play an integral role in NCD and oral health care integration by creating awareness, promoting oral health, controlling risk factors, and referring for timely dental care. This study aimed to identify and understand the roles of the existed human health resources working at primary health care and develop strategies to build on a unified NCD and oral health alliance human resources at this level. A scoping review was conducted to identify the primary health workforce in the Southeast Asia region, their roles and responsibility, and integration in oral health care. Various databases like NCBI (PubMed), Google Scholar, World Health Organisation (WHO)-Southeast Asia region (SEAR), Ministry of Health and Family Welfare websites in SEAR were comprehensively searched from January 1980 to December 2020 for reports, reviews, and original research. The keywords used were "primary health care workers," "community health care workers," "primary oral health care in SEAR," etc. Only full-text articles in English language and reports available in Ministry of Health and Family Welfare (MOHFW) sites of SEAR were included in the study. Information was taken from 39 full-text articles, six WHO reports, and two reports from Ministry of Health sites of SEAR. Primary health workers (PHW) are known by multiple names in different countries of Southeast Asia. They share various common roles and responsibilities. There are many opportunities for the prevention and control of oral diseases in the SEAR. Basic systems and human resources for the control of NCD are in place in many countries. Oral health can be integrated with NCD programs and policies to reduce the burden of diseases.

Public-private partnerships in primary health care: a scoping review

Background

The Astana Declaration on Primary Health Care reiterated that PHC is a cornerstone of a sustainable health system for universal health coverage (UHC) and health-related Sustainable Development Goals. It called for governments to give high priority to PHC in partnership with their public and private sector organisations and other stakeholders. Each country has a unique path towards UHC, and different models for public-private partnerships (PPPs) are possible. The goal of this paper is to examine evidence on the use of PPPs in the provision of PHC services, reported challenges and recommendations.

Methods

We systematically reviewed peer-reviewed studies in six databases (ScienceDirect, Ovid Medline, PubMed, Web of Science, Embase, and Scopus) and supplemented it by the search of grey literature. PRISMA reporting guidelines were followed.

Results

Sixty-one studies were included in the final review. Results showed that most PPPs projects were conducted to increase access and to facilitate the provision of prevention and treatment services (i.e., tuberculosis, education and health promotion, malaria, and HIV/AIDS services) for certain target groups. Most projects reported challenges of providing PHC via PPPs in the starting and implementation phases. The reported challenges and recommendations on how to overcome them related to education, management, human resources, financial resources, information, and technology systems aspects.

Conclusion

Despite various challenges, PPPs in PHC can facilitate access to health care services, especially in remote areas. Governments should consider long-term plans and sustainable policies to start PPPs in PHC and should not ignore local needs and context.

Program for Dental Health Advancement in Children "Dental Passport"

Objective

The need for improving oral health in the Republic of Croatia was based on health indicators and poor oral health status and resulted in the implementation of measures to improve the use of dental health care for schoolchildren through the national program called “Dental Passport”, which began in the 2017/2018 school year.

Purpose

The aim of this study was to present the content and results of its implementation and to analyse them with emphasis on the sustainability and inclusion of the program and its implementation in preventive activities and procedures.

Material and Methods

The data were collected from the completed “Dental Passport” forms from September 2017 to August 2018. The dental examinations and diagnostic-therapeutic procedures were recorded in The Central Health Information System of Croatia.

Results

In the school year 2017/2018, 24,729 6^th grade elementary school students visited a dentist. The response rate in the Republic of Croatia was 68%. According to the CEZIH data, in the period from September 1 to December 31 2017, an increase in the number of first examinations and diagnostic-therapeutic procedures was observed in children aged 12 years, compared to the same period in 2015. The least reported preventive procedures in preschool children and 6^th grade students were fissure sealing and sealing restorations, while motivating and instructing children on oral hygiene were the most common reported procedures.

Conclusion

Good organization of work in school medicine provides the basis for the implementation of dental programs involving schoolchildren. However, greater motivation of the dental health care provider in the implementation of preventive procedures and motivation of parents and patients for a more active involvement in the “Dental Passport” program are important determinants in further implementation and improvement of oral health in children.

What we know about management and organisation of primary dental care in Brazil

This cross-sectional study evaluated the management and organisation of primary dental care in Brazil. For this purpose, data from the National Program for Improving Access and Quality of Primary Care (PMAQ-AB) were used. Dentists from 18,114 Oral Health Teams (OHTs) answered a structured questionnaire in 2014. The data were analyzed descriptively and by cluster analysis. Half the Brazilian OHTs (51.0%) undertake planning and programming of activities. The majority of OHTs (66.4%) conducted monitoring and analysis of indicators and oral health information. The majority of OHTs had performed some self-evaluation process in the last 6 months (67.5%) and utilised self-evaluation results for planning and programming actions (71.4%). The OHTs grouped in Cluster 1 demonstrated better management organisation, followed by the teams grouped in Cluster 2. In the Brazilian macro-regions, the more OHTs were grouped in Cluster 1 in the Southeast (87.5%), Northeast (85.4%) and South (82.7%) regions. The majority of OHTs have satisfactory management and organisation. However, some need improvement, mainly in planning and programming actions based on health indicators and self-evaluation. All Brazilian OHTs need to participate in PMAQ-AB and it is important to continue evaluating the data to improve oral health care.

Integration of oral health into primary health care: A systematic review

Integration of oral health into primary health care holds the key to affordable and accessible health care as oral health is still a neglected component in many countries. This review aims to determine integration of oral health into primary health care and provide an evidence-based synthesis on a primary oral healthcare approach. Searches were conducted in various databases like Biomed Central, MEDLINE, Cochrane databases, NCBI (PubMed), Sci-Hub, Google Scholar, and WHO sites. The studies included in this review are according to the following eligibility criteria: the articles in English language, the articles published from January 2000 to October 2018, and only full text article. The search yielded 500 articles. After removal of duplicates: 410 articles screened based on title and abstract, 100 full text articles were assessed for eligibility, and 30 full text articles were included. This review showed evidence how oral health is related to general health: focused on common risk factor approach and bidirectional relationship. There are various ways of integration, such as interprofessional education, interprofessional collaborative practice, closed-loop referral process, and various public and private partnerships, and at the same time, there are a lot of barriers in integration. Thus, the primary oral health care needs to be developed as an integral part of primary health care. Consequently, there is a need to increase finance, health care workforce, government support, and public-private partnership to achieve the goal of affordable and accessible health care, i.e. health for all.

FDI-Unilever Brush Day & Night partnership: 12 years of improving behaviour for better oral health

Twelve years ago, FDI World Dental Federation and Unilever Oral Care began a partnership to raise awareness of oral health globally. This aim reflects FDI's mission to "lead the world to optimal oral health", and one of the goals set by the Unilever Sustainable Living Plan "to improve health and well-being for more than 1 billion" by 2020. This partnership has developed a series of public health programmes to improve the brushing habits of targeted populations through health promotion and educational campaigns worldwide. Building on the success of the first two phases of the partnership, the third phase (Phase III), named Brush Day & Night, aimed to educate children in brushing twice-daily with fluoride toothpaste via a 21 Day school programme. This article reports the main outcomes of the past 12 years of this partnership, in particular the key outreach and figures of Phase III evaluation. School programmes were implemented in 10 countries, where local teams collected data from children aged between 2 and 12 years to monitor their oral health behaviours using specific indicators. In addition to the school programme, the World Oral Health Day was used as a vehicle to convey oral health awareness to influential governing bodies and the public. As a result, over 4 million people were directly reached by the programme in 2016.

Global burden of dental condition among children in nine countries participating in an international oral health promotion programme, 2012-2013

The Live.Learn.Laugh. phase 2 programme is a unique global partnership between FDI World Dental Federation and Unilever Oral Care which aims to provide measurable improvement of oral health on a global scale through encouraging twice-daily brushing with a fluoride toothpaste. It was based on international recommendations using the principles of health promotion within school for the implementation of preventive health strategies. This paper is an overview of the dental caries condition of children from 2012 to 2013 in nine countries included in four World Health Organisation (WHO) regions. A cross-sectional study was conducted in each country before the implementation of health-promotion measures focused on twice-daily toothbrushing with fluoride toothpaste. The sample was based on stratified sampling according to the WHO pathfinder recommendations. From a total of 7,949 children examined, there were 517 children (1-2 years of age), 1,667 preschool children (3-5 years of age) and 5,789 schoolchildren (6-13 years of age). The prevalence and severity of primary dental caries, early childhood caries and temporary dental caries were described using decayed, filled teeth (dft), permanent decayed, missing, filled teeth (DMFT) indices and the significant caries index (SCI). The major findings were a high prevalence of caries, identification of high-risk groups and inequality in the distribution of the severity of dental conditions. Aggregated data from this overview should provide justification for implementing an oral health programme. The main point is the need to retain and expand the community fluoridation programme as an effective preventive measure. At the individual level, the aggregated data identify the need for more targeted efforts to reach children early - especially among specific high-risk groups.

Attitude of dental hygienists, general practitioners and periodontists towards preventive oral care: an exploratory study

INTRODUCTION

Promoting oral hygiene and stimulating patient's responsibility for his/her personal health remain challenging objectives. The presence of dental hygienists has led to delegation of preventive tasks. However, in some countries, such as Belgium, this profession is not yet legalized. The aim of this exploratory study was to compare the attitude towards oral-hygiene instructions and patient motivational actions by dental hygienists and by general practitioners/periodontists in a context without dental hygienists.

MATERIALS AND METHODS

A questionnaire on demographics (six items), oral-hygiene instructions (eight items) and patient motivational actions (six items) was distributed to 241 Dutch dental hygienists, 692 general practitioners and 32 periodontists in Flanders/Belgium. Statistical analysis included Fisher's exact-test, Pearson's chi-square test and multiple (multinomial) logistic regression analysis to observe the influence of profession, age, workload, practice area and chair-assistance.

RESULTS

Significant variance was found between general practitioners and dental hygienists (in 13 of 14 items), between general practitioners and periodontists (in nine of 14 items) and between dental hygienists and periodontists (in five of 14 items). In addition to qualification, chair-assistance was also identified as affecting the attitude towards preventive oral care.

CONCLUSION

The present study identified divergence in the application of, and experienced barriers and opinions about, oral-hygiene instructions and patient motivational actions between dental hygienists and general practitioners/periodontists in a context without dental hygienists. In response to the barriers reported it is suggested that preventive oriented care may benefit from the deployment of dental hygienists to increase access to qualified preventive oral care.

Realist evaluation of intersectoral oral health promotion interventions for schoolchildren living in rural Andean communities: a research protocol

BACKGROUND

Intersectoral collaboration, known to promote more sustainable change within communities, will be examined in an oral health promotion program (OHPP). In Peru, an OHPP was implemented by the Ministry of Health, to reduce the incidence of caries in schoolchildren. In rural Andean communities, however, these initiatives achieved limited success. The objectives of this project are: (1) to understand the context and the underlying mechanisms associated with Peruvian OHPP's current effects among school children living in rural Andean communities and (2) to validate a theory explaining how and under which circumstances OHP intersectoral interventions on schoolchildren living in rural Andean communities produce their effects.

METHODS AND ANALYSIS

Through a realist evaluation, the context, underlying mechanisms and programme outcomes will be identified. This process will involve five different steps. In the first and second steps, a logic model and an initial theory are developed. In the third step, data collection will permit measurement of the OHHP's outcomes with quantitative data, and exploration of the elements of context and the mechanisms with qualitative data. In the fourth and fifth steps, iterative data analysis and a validation process will allow the identification of Context-Mechanism-Outcome configuration, and validate or refine the initial theory.

ETHICS AND DISSEMINATION

This research project has received approval from the Comité d'éthique de la recherche en santé chez l'humain du Centre hospitalier universitaire de Sherbrooke. The initial theory and research results will be published in relevant journals in public health and oral health. They will also be presented at realist evaluation and health promotion international conferences.

A Colorimetric Interdental Probe as a Standard Method to Evaluate Interdental Efficiency of Interdental Brush

The aim of this study is to evaluate the concordance between the empirical choice of interdental brushes of different diameters compared to the gold standard, the IAP CURAPROX(©) calibrating colorimetric probe. It is carried out with the aim of facilitating the consensus development of best practices. All the subjects' interproximal spaces were evaluated using the reference technique (colorimetric probe), then after a time lapse of 1.2 ± 0.2 hours, using the empirical clinical technique (brushes) by the same examiner. Each examiner explored 3 subjects. The order the patients were examined with the colorimetric interdental probe (CIP) was random. 446 sites were selected in the study out of 468 potential sites. The correspondence of scores between interdental bushes vs. colorimetric probe is 43.0% [95%-CI: 38.5-47.6]. In 33.41% of the 446 sites, the brush is inferior to the probe; in 23.54% of cases, the brush is superior to the probe. Among the discrepancies there is thus a tendency for the subjects to use brushes with smaller diameter than that recommended by the colorimetric probe. This review has found very high-quality evidence that colorimetric probes plus interdental brushing is more beneficial than interdental brushing alone for increase the concordance between the empirical choice of interdental brushes of different diameters compared to the gold standard. Uncertainties remain and further research is required to provide detailed data on user satisfaction.