Effect of a school-based oral health education programme on use of recommended oral self-care for reducing the risk of caries by children in Nigeria

Effectiveness of an oral health promotion training program among school nurses in India

BACKGROUND

Schools are a valuable platform for oral health promotion and the role of school nurse is critical in promoting oral health of children. A training program was carried out to assess its effectiveness in promoting oral health among school nurses of Navodaya Vidyalaya Samiti (NVS), one of the largest groups of central schools in India.

METHODOLOGY

A total of 557 school nurses of Navodaya Vidyalaya schools participated in the training program. The training was delivered virtually using didactic teaching methods based on a conceptual framework. Pre and post knowledge scores were assessed for all the participants.

RESULTS

A total of 451 pre-post complete responses were received during training program, with a response rate of 81 %. There was significant improvement in the overall knowledge scores (p < 0.001) of school nurses. After the training program was completed, oral health screening and education for students was conducted by these trained nurses in coordination with teachers in their respective schools.

CONCLUSION

The present training program was effective in addressing the gaps in oral health knowledge of the school nurses and significantly improving their oral health knowledge.

Impact of oral hygiene habits on oral health-related quality of life of in-school adolescents in Ibadan, Nigeria

Background

Recent evidence has shown that the prevalence of periodontal diseases is still high among adolescents and, thus, there is an impetus to promote good oral hygiene habits among them through schools. There is a need to provide baseline data on the oral hygiene habits of adolescents and how it impacts their oral health-related quality of life for appropriate intervention to be instituted. Moreover, oral health-related quality of life describes how oral health affects the daily activities of individuals; thus, it provides a holistic means of involving individuals in making decisions about their oral health including uptake of oral hygiene habits.

Aim

To assess the impact of oral hygiene habits on adolescents' oral health-related quality of life.

Methods

A cross-sectional study was conducted among 1,800 adolescents aged 14–18 years attending 36 Senior Secondary Schools in the metropolis of Ibadan, Nigeria. Data were collected using a self-administered questionnaire, which assessed students' sociodemographic characteristics, oral hygiene habits, and oral health-related quality of life with COHIP-SF19. Data obtained was analyzed with SPSS version 25 and the p-value was set at <5%.

Results

The mean age of the adolescents was 15.16 (±1.16) years. Many 1,094 (60.3%) cleaned their teeth twice or more often daily with 126 (7.0%) cleaning after meals and 1,519 (84.4%) changing their tooth cleaning agent at three months intervals or less. About 1,215 (67.5%) spent three minutes or longer in cleaning their teeth. Only a few 238 (13.2%) cleaned interdentally and 137 (7.6%) used dental floss. The OHRQoL scores of the adolescents ranged from 9–76. A total of 1,612 (93.5%) had at least an impact on their OHRQoL. Those who cleaned their teeth more frequently (twice or more) were more likely to have better OHRQoL (OR = 1.6, 95% CI = 1.1–2.4, p = 0.025) and those who did not clean interdentally were more likely to have better OHRQoL (OR = 2.8, 95% CI = 1.2–6.5, p = 0.014) than others.

Conclusion

The oral hygiene habits of the adolescents were suboptimal and those who cleaned their teeth twice or more often each day had fewer impacts on their OHRQoL, whereas those who engaged in interdental cleaning had higher impacts on their OHRQoL than others.

Strengthening the oral health system in Nigeria: A health systems building block approach

AIM

The present study aimed to describe the building blocks of the oral health system, including the role that the community plays in strengthening the oral health system in Nigeria.

METHODOLOGY

This research was a scoping review of the existing literature retrieved from search engines and databases. Thus, we utilised grey literature, peer-reviewed literature, policy documents and websites. The oral health system was analysed using the World Health Organisation's Health systems framework, and we adapted this framework by introducing a seventh block, community participation. We also inserted the links between the oral health service delivery and oral health workforce blocks of the framework to improve the oral health outcomes.

RESULTS

More dental clinics are required to improve the availability and accessibility of oral health services. Dental workforce expansion is imperative. This can be approached by training of junior cadre dental professionals and incorporating community health practitioners to deliver basic oral care. There is an unregulated access to medication to treat dental conditions; hence, oral disease treatments need to be included in the country's treatment guidelines to improve standard of care. The government needs to improve on overall health spending and invariably increase oral health care allocation urgently. Furthermore, the country's stewardship of oral health care is hinged on well disseminated and implemented national policies on oral health. The oral health system can achieve its overall goals with community participation, engagement and ownership.

CONCLUSION

Strengthening the oral health system in Nigeria requires urgent attention on each building block and cross-cutting interventions across the system's building blocks. The role of the community will need to be recognised because it is vital in sustaining any organisational change.

Effectiveness of primary school-based interventions in improving oral health of children in low- and middle-income countries: a systematic review and meta-analysis

Background

Risk factors for oral disease can potentially be ameliorated by school-based interventions. This review evaluates the effectiveness of primary school-based interventions in improving oral health among children in low-and middle-income countries (LMICs).

Methods

Our systematic review was conducted in accordance with the Joanna Briggs Institute methodology for systematic reviews of effectiveness. Medline, Embase, Global Health, CINAHL, Emcare, Scopus, Web of Science, WHO website, Google Advanced and Google Scholar were searched for experimental and observational studies published between 1995 and 2021 in English. Quality assessment and data extraction of the articles were performed by two independent reviewers. The primary outcome was decayed, missing, and filled teeth/surfaces [dmft(s)/DMFT(S)] scores. Seven meta-analyses were conducted.

Results

The search yielded 1178 publications and after removing duplicates, 753 remained. A further 648 publications were excluded after screening titles and abstracts. 105 publications were reviewed in full and 34 were included. Narrative synthesis showed school-based interventions had a positive effect on oral health outcomes. Meta-analysis showed a significant positive effect on dental caries measured by DMFT scores (standardised mean difference (SMD) =  − 0.33; 95% CI − 0.56 to − 0.10; P = 0.005), net increment in DMFS scores (SMD =  − 1.09; 95% CI − 1.91 to − 0.27; P = 0.009), dmft and DMFT/S score > 1 (Risk Ratio = 0.70; 95% CI 0.53 to 0.94; P = 0.02) and plaque scores (SMD =  − 0.32; 95% CI − 0.46 to − 0.18; P < 0.00001). Non-significant positive effect was observed for dental caries measured by net increment in DMFT scores (SMD =  − 0.34; 95% CI − 0.69 to 0.02; P = 0.06) and DMFS scores (SMD =  − 0.26; 95% CI − 0.70 to 0.18; P = 0.24), and gingival health (SMD = 0.12; 95% CI − 0.32 to 0.55; P = 0.60). Certainty of evidence was assessed as very low for all oral health outcomes.

Conclusion

School-based interventions can be effective in reducing the burden of oral disease among primary school children in LMICs, with skills-based education, teacher training, provision of access to oral health services and parental engagement emerging as particularly promising. Further research is required to provide evidence of effectiveness of primary school-based interventions to improve oral health.

Systematic review registration The title of this review was registered with PROSPERO (registration number: CRD42020202599).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02291-2.

A scoping review of intervention components of school-based oral health-related behavioural interventions using the Theoretical Domains Framework

The aim of this study was to review the intervention components of school-based oral health-related behavioural interventions using the Theoretical Domains Framework (TDF). We identified relevant papers from the review of Cooper et al., and these papers came from both the original inclusion and exclusion article lists. We also modified and updated their search strategies (2013 - April 2019). The 53 included papers reported on 79 interventions (experimental groups = 57 interventions, control groups = 22 interventions). Most of the papers used three to nine domains (average = 5.6) in their experimental interventions, and the most commonly used domains were 'knowledge,' 'skills,' 'social influences,' and 'environmental context and resources.' Considering the complexity of intervention components in one programme, there is no one specific domain or domain set that can determine the success of behavioural interventions. The design of future programmes should be guided by a complex intervention methodology. However, the best combination set might not exist, and the choice of domains should depend on local context or resources. This study can be used as a resource for identifying previous papers, which have used the same domains.

Impact of the Brush Day & Night Programme on Oral Health Knowledge and Behaviour in Children

OBJECTIVES

School-based interventions can establish positive behaviours that reduce the likelihood of oral diseases later in life. The Brush Day & Night (BDN) programme is a 21-day school-based educational programme to promote good oral health behaviours. This study aims to evaluate the effect of the BDN programme on oral health knowledge and behaviour outcomes in children after the intervention as compared to a control group over 24 weeks.

METHODS

This was a superiority cluster randomised trial of children aged 6-12 years from Indonesia (N = 2021) and Nigeria (N = 750). All children were provided with toothpaste and a toothbrush, and the intervention groups (N = 1107 and 439, respectively) received the 21-day BDN programme. Children were followed up at Weeks 3, 8, and 24 after the programme start date and completed a questionnaire addressing the objectives at all timepoints. Improvement in oral health knowledge and behaviour was calculated based on the percentage of positive change in answers and analysed based on a conditional logistic approach for each evaluation timepoint, compared with control, with a 95% CI.

RESULTS

After 24 weeks, Indonesian children following the BDN programme presented with a 30% and 60% additional probability, respectively, of adequate timing of toothbrushing and of being aware of the importance of adequate toothbrushing frequency compared with control. In Nigeria, after 24 weeks, children following the BDN programme had a 92% and 73% higher probability of adequate toothbrushing frequency and of using fluoride toothpaste, respectively, compared with control.

CONCLUSIONS

The BDN programme is effective at improving children's knowledge and behaviour compared with a control population.

Teaching Preschool Children Correct Toothbrushing Habits Through Playful Learning Interventions: A Randomized Controlled Trial

PURPOSE

This study aimed to investigate the effect of playful learning interventions (with toys, visual and auditory sources) on appropriate toothbrushing behaviors and the amount of accumulated plaque in preschool children.

DESIGN AND METHODS

The study was carried out as a parallel-group, randomized and controlled study during the period October-December 2018, with 100 preschool children. The preschool students were randomly assigned to an intervention and a control group. The children in the intervention group were given instructions on how to brush their teeth while the children in the control group were not given any instruction outside of what they had learned in preschool. The playful learning interventions that were carried out consisted of three rounds of meetings designed to educate the children about adopting appropriate toothbrushing behaviors.

RESULTS

The study groups were well matched at baseline (p = .537) and the intervention group showed statistically significant improvements in toothbrushing (p = .001) and plaque control (p = .001) following the intervention in comparison to the controls. Additionally, while the amount of plaque decreased in the children in the intervention group (p = .001), plaque increased in the control group after the intervention (p = .001).

CONCLUSIONS

This study showed that after the playful learning interventions carried out with the preschool children, appropriate toothbrushing behaviors were acquired and there was a decrease in the amount of plaque.

APPLICATION TO PRACTICE

Nurses who work with preschool children could use toys and songs as effective and entertaining nursing interventions for developing correct toothbrushing behaviors.

Association between nutritional status and early childhood caries risk profile in a suburban Nigeria community

BACKGROUND

Malnutrition is associated with oral health problems.

AIM

To determine the association between malnutrition (undernourished and over-nourished) and early childhood caries (ECC) in a suburban population in Nigeria.

DESIGN

Data were extracted from a database of a household survey of 1549 under 6-year-old children. Explanatory variables were nutritional status (normal, undernourished [wasted, stunted and underweight], or over-nourished). The outcome measure was the prevalence of ECC. Children's sociodemographic characteristics (socio-economic status, sex, age) and caries-risk variables (frequency of sugar consumption in-between-meals, oral hygiene status) were the confounders. Association between ECC and malnutrition was determined using the Poisson regression analysis. Statistical significance was set at P ≤ .05.

RESULTS

About one-third (31.4%) of children had expected height/weight for age; 848 (54.7%) were undernourished; and 215 (13.9%) were over-nourished. Nutritional status was not significantly associated with the prevalence of ECC. Children who consumed sugar in-between-meals three or more times a day were twice as likely to have ECC as were those who consumed sugar less often in-between-meals (APR: 2.23; 95% CI: 1.30-3.81; P = .003). Children 3-5 years old were more likely to have ECC than were those 0-2 years old (APR: 2.40; 95% CI: 1.10-5.22; P = .03).

CONCLUSIONS

ECC was not associated with undernourished and over-nourished in a suburban population in Nigeria.

Use of teachers as agents of oral health education: Intervention study among public secondary school pupils in Lagos

Background:

Common oral diseases are preventable and if detected early are reversible and schools provide a setting in which the oral health behavior of pupils can be influenced. We aimed to assess the effectiveness of using teachers in place of oral health professionals to deliver oral health education (OHE) in public secondary schools in Lagos State.

Methods:

This quasi-experimental study was conducted in four phases from September 2016-April 2017. A multistage sampling method was adopted to enlist the research participants from four enlisted schools, which were randomly assigned into two groups. Trained dentists delivered OHE in the first group of schools while trained teachers did in the second group and the impact of the intervention was assessed over six months. P values for significant differences were set at 0.05.

Results:

At the 3 months evaluation, the mean oral health knowledge (OHK) scores were higher among pupils in the Teachers Intervention Schools (TIS) (71.3 ± 19.3) than that in the Dentist Intervention Schools (DIS) (61.3 ± 17.7) (P = 0.023). Subsequent evaluation sessions from baseline revealed a gradual increase in the proportion of pupils with positive oral health attitude scores; with a higher proportion of pupils in the DIS (34.5%) compared to the TIS (34.0%) at 6 months assessment time. At 6 months evaluation, the proportion of pupils with poor oral health practices decreased in both groups of schools (P = 0.104).

Conclusion:

The proportion of pupils with good OHK was higher in the TIS at post-intervention periods; this difference was statistically significant at 3 months. This result suggests that teachers are as effective as dentists in delivering OHE.

Advancing Oral Health Equity Through School-Based Oral Health Programs: An Ecological Model and Review

In the United States and elsewhere, children are more likely to have poor oral health if they are homeless, poor, and/or members of racial/ethnic minority and immigrant populations who have suboptimal access to oral health care. As a result, poor oral health serves as the primary marker of social inequality. Here, the authors posit that school-based oral health programs that aim to purposefully address determinants of health care access, health and well-being, and skills-based health education across multiple levels of influence (individual/population, interpersonal, community, and societal/policy) may be more effective in achieving oral health equity than programs that solely target a single outcome (screening, education) or operate only on the individual level. An ecological model is derived from previously published multilevel frameworks and the World Health Organization (WHO) concept of a health-promoting school. The extant literature is then examined for examples of evaluated school-based oral health programs, their locations and outcomes(s)/determinant(s) of interest, the levels of influence they target, and their effectiveness and equity attributes. The authors view school-based oral health programs as vehicles for advancing oral health equity, since vulnerable children often lack access to any preventive or treatment services absent on-site care provision at schools. At the same time, they are incapable of achieving sustainable results without attention to multiple levels of influence. Policy solutions that improve the nutritional quality of children's diets in schools and neighborhoods and engage alternative providers at all levels of influence may be both effective and equitable.

School-Based Dental Education for Improving Oral Self-Care in Mexican Elementary School-Aged Children

Aim. To test the efficiency and acceptance of school-based dental education for improving oral self-care in Mexican elementary school-aged children. Method. A total of 408 students from 4 schools were examined at the baseline, 3 months (follow-up rate was 94%) and 6 months observations (follow-up rate 91%). Group 1 served as a control, Group 2 received a lecture-based education, and Group 3 consisted of trained peer-leaders who educated their peers. Oral self-care practice and oral self-care skills were assessed at the baseline and both follow-ups. A number of sociodemographic and oral health behavior/knowledge characteristics were tested as predictors of oral self-care outcomes at different observation periods. Results. Oral self-care outcomes improved in Groups 2 and 3, but not in the control group. The selected child population, their caregivers and teachers perceived the school-based educational strategy as important and necessary. There was no consistent pattern of predictors explaining variations in oral self-care outcomes at any of the observation periods. Oral self-care improvement observed at the 6 months observation was mainly predicted by the baseline oral self-care levels, dental education, and age. Conclusions. The school-based dental education was easy to implement, and it was effective for improving children's oral self-care practice and skills.

Effectiveness of oral health education intervention among female primary school children in Riyadh, Saudi Arabia

Objective

This study aimed to examine the effectiveness of oral health intervention on the improvement in knowledge and self-reported oral health behavior among 6–8 year old female primary school children in Riyadh, Saudi Arabia.

Materials and methods

The sample consisted of 1661 girls in primary schools who are 6 to 8-year-olds (first, second and third graders). The children’s level of knowledge was assessed by a self-administered questionnaire that was formulated for this specific age and divided into two parts; oral health knowledge and self-reported oral health behavior. There were seven multiple choice questions and one true/false question with five underlying parts in the questionnaire which contained basic information about oral health knowledge, oral hygiene practices and certain habits that affect teeth. The questionnaires were distributed before and six weeks after implementation of the oral health educational program to measure the level improvement of knowledge regarding oral health among these children.

Results

All the questions showed statistically significant improvement in knowledge and self-reported behavior in the post intervention group. There was a significant increase in the level of knowledge by 11.24% and level of self-reported behavior by 25% after intervention (P < 0.001). The highest net change in the knowledge due to intervention was noted among third graders (13.3%), whereas for self-reported oral health behavior, it was noted among first graders (28.3%).

Conclusion

The results of this study showed that an easy-to-organize and inexpensive school-based intervention can, on a short-term basis, be effective in improving the knowledge and self-reported oral health behavior of children.

Screening Children for Caries: An Ethical Dilemma in Nigeria

Dental caries is the main oral health challenge for children in Nigeria. Concern about its negative impact makes screening for caries in children an attractive public health strategy. The ability to detect the preclinical phase of caries, the availability of screening tools with high accuracy, and the possibility of treatment before onset of clinical symptoms with significant cost and health benefits, makes it appropriate for screening. However in Nigeria, the poor availability of highly specific and sensitive screening tools, poor access to oral health care and concerns with pre-screening consent, raise the question of the appropriateness of conducting screening programmes for children. We argue that a number of structural challenges associated with poor uptake of oral health care services need to be addressed before screening for caries can be considered ethically appropriate. These include facilitating access of children to quality oral health care and a systematic national approach to oral health implementation. Failure to address challenges associated with dental service utilization by children in Nigeria increases the risk of screening programmes promoting inequitable access to oral health care services.

The Associations of School Oral Health-Related Environments with Oral Health Behaviours and Dental Caries in Children

Creating supportive oral health-related environments in schools is an important strategy for promoting schoolchildren’s oral health. This study determined the associations between school environments and children’s oral behaviour and dental caries. The data on school oral health-related environments were obtained through observation and interviews. Oral behaviour and dental caries data were collected through interviews and oral examinations of 984 sixth grade children. χ2 and multiple logistic regression, adjusted for sociodemographic and economic status, other school environment variables, and oral behaviour were used. Providing fresh fruit with school meals was associated with low sweets consumption and low caries levels. Children’s daily sweets consumption was positively associated with sweetened milk sales in schools. Selling sweetened beverages, including sweetened milk, sweetened drinks, and soft drinks, was associated with high caries levels, while selling meat and crispy packed snacks was associated with low caries levels. Children in schools with integrated oral health education were significantly more likely to brush their teeth twice a day and to brush after lunch. In conclusion, school oral health-related environments, especially available food choices, were associated with sweets consumption behaviour and caries levels. Children in schools with integrated oral health education had better brushing habits.

Are educating and promoting interventions effective in oral health?: A systematic review

OBJECTIVE

It is estimated that about 20%-25% of the world's population are suffering from periodontal diseases or severe gum diseases. This requires appropriate interventions. For the development of effective and evidence-based programmes tailored to the target group, the aim of this review was to survey to the effectiveness of oral health education and promotion interventions in the relevant groups of people.

METHODS

The electronic databases including PubMed, EMBASE, Web of science and Cochrane Library were searched for English language studies between 2010 and (January-December) 2016. To assess the quality of articles, the checklist was used that includes 19 items. Studies were selected based on PICOs criteria, and finally, 16 studies were entered in our study.

RESULTS

A total of 16 articles were selected, classified into two groups (A and B groups), so that group A with short-term effects includes improving knowledge, attitudes, self-efficacy, oral health behaviour (toothbrushing and flossing), theoretical constructs (perceived susceptibility, perceived severity and perceived behavioural control) which consists of 15 articles and group B with long-term effects includes improving decayed teeth, plaque, calculus and bleeding which consists of six articles.

CONCLUSION

Approximately, this study supports effectiveness of all oral health education and promotion interventions, especially in short-term outcomes. Regarding the importance of long-term and short-term outcomes for oral health education and promotion programmes, These interventions could be performed in the future with several target groups including family and teachers.

Evaluation of the Effectiveness of a Primary Preventive Dental Health Education Programme Implemented Through School Teachers for Primary School Children in Mysore City

Aims and Objectives:

The present study was conducted with the aim of evaluating the effectiveness of a Primary Preventive Dental Health Education Programme conducted for 6–12-year-old primary school children in Mysore City.

Materials and Methods:

A total of 12 schools, one each in the category of Government, Aided, and Unaided, were randomly selected per zone viz., North, South, East, and West. These 12 schools constituted the study group where the Primary Preventive School Dental Health Education Programme (PPSDHEP) was implemented. Two additional schools were selected at random from the four zones to serve as the control. A total of 926 children participated in the study. The PPSDHEP involved the second-level transfer of preventive package wherein the oral health education was imparted to the school children by schoolteachers trained by the investigator. Among the parameters for evaluating the outcome of the programme were the pre and post-programme assessment (at the baseline and at follow-up, i.e., after 6 months) of knowledge, attitude, and practice (KAP), dental caries status, oral hygiene, and gingival health status.

Results:

The results suggest that the PPSDHEP resulted in bringing about an enhancement in the KAP towards oral health and also an improvement in dental caries, oral hygiene, and gingival health status of the school children in the study group.

Conclusion:

The present study supports the implementation of similar programmes in schools and the contention that schoolteachers are suitable personnel for imparting dental health education to school children on a regular basis.

Digit Sucking, Age, Sex, and Socioeconomic Status as Determinants of Oral Hygiene Status and Gingival Health of Children in Suburban Nigeria

BACKGROUND

This study determines prevalence of digit sucking and gingivitis, and association among age, sex, socioeconomic status, presence of digit-sucking habits, oral hygiene status (OHS), and gingivitis among a group of Nigerian children.

METHODS

Data of 992 children aged 1 to 12 years recruited through a household survey conducted in Osun State, Nigeria were analyzed. Information on age, sex, socioeconomic status, and history of digit-sucking habits were collected. Children were assessed for OHS and severity of gingivitis using the simplified oral hygiene index and the gingival index, respectively. Predictors of presence of gingivitis and poor oral hygiene were determined using multivariate logistic regression.

RESULTS

One (0.2%) and 454 (93.0%) children aged 1 to 5 years had poor oral hygiene and mild gingivitis, respectively. Twenty-two (4.4%) and 361 (72.9%) children aged 6 to 12 years had poor oral hygiene and mild gingivitis, respectively. The odds of having poor oral hygiene (adjusted odds ratio [AOR]: 0.26; 95% confidence interval [CI]: 0.20 to 0.35; P <0.001) and gingivitis (AOR: 0.21; 95% CI: 0.14 to 0.31; P <0.001) was significantly reduced for children aged 1 to 5 years. The odds of having gingivitis was increased in children with low socioeconomic status (AOR: 2.09; 95% CI: 1.32 to 3.31; P = 0.002). There was no significant relationship among sex, digit sucking, OHS, and presence of gingivitis.

CONCLUSIONS

A digit-sucking habit did not increase chances of having poor oral hygiene and gingivitis. Increasing age and low socioeconomic status were factors that significantly increased chances of having poor oral hygiene and gingivitis.

Use of caries prevention tools and associated caries risk in a suburban population of children in Nigeria

AIMS

To determine the association between use of recommended oral self-care (ROSC) caries prevention tools and presence of dental caries in children resident in suburban Nigeria.

METHODOLOGY

Secondary analysis was conducted for a dataset generated for 1-12 years old children recruited through a household survey. Information on use of ROSC caries prevention tools (brushing more than once a day, use of fluoridated toothpaste always, and eating sugary snacks between main meals less than once a day), use of oral health adjuncts (dental floss, mouth rinses, other tooth cleansing agents) and presence of caries were extracted. The odds of having caries when ROSC caries prevention tools were used singly or in combination, were determined using multivariate logistic regression adjusted for age and sex.

RESULTS

The single or combined use of ROSC caries prevention tools had no statistically significant association with presence of caries. Brushing more than once a day reduced the odds of having caries while consumption of sugar between meals once a day or more increased the odds of having caries after adjusting for age and gender. The use of two ROSC caries prevention tools reduced the risk for caries (AOR 0.28; 95 % CI 0.05-1.53) when adjusted for age. The converse was observed when adjusted for gender (AOR 1.15; 95 % CI 0.38-3.45). The largest effect size was observed when sugary snacks were taken once a day or more between meals after adjusting for age (AOR 5.74; 95 % CI 0.34-96.11).

CONCLUSION

The use of a combination of fluoridated toothpaste and twice-daily tooth brushing had the largest effect on reducing the chance for caries in children resident in Ile-Ife, Nigeria.

Barriers and facilitators of dental service utilization by children aged 8 to 11 years in Enugu State, Nigeria

BACKGROUND

Multiple factors influence a child's ability to access oral health care. The aim of this study was to identify factors that facilitated and served as barriers to children's utilization of oral health care services in Enugu, Nigeria.

METHODS

The study recruited 1406 primary school pupils aged 8 to 11 years. All the children received oral health education, with the aid of an oral health education curriculum appropriate for their age. After this, referral letters were given to the children. Twelve months later, the study participants were revisited in their schools to obtain information on their reasons for utilizing, or not utilizing an oral health care service in the last 12 months. The association between socio-economic status; form of parenthood; number of siblings, birth rank and reasons for utilization and non-utilization of dental services were assessed. Influence on the child's predisposition to oral health service utilization on dental visit was also assessed.

RESULTS

Only 116 (14.7 %) of the 791 children accessible during the 12 months follow-up visit had visited the dental clinic and the main reason for utilization was the desire to fulfill the dentist's request for dental visit (41.9 %) while parents' inability to make out time for a dental visit (43.3 %) was the main reason for non-utilization. The odds of utilizing oral health care services for study participants from the middle (AOR: 0.50; CI: 0.31-0.79; P = 0.003) and low (AOR: 0.24; CI: 0.13-0.45; p = <0.001) socioeconomic strata, and those living with guardians/relatives (AOR: 0.08; CI: 0.01-0.60; p = 0.01) were decreased when compared to those living with both parents, respectively. Respondents with positive perception about dental service utilization had increased odds of utilizing oral health care (AOR: 2.96; CI: 1.48-5.90; p = 0.002).

CONCLUSION

Dentists can be strong motivators for children to utilize oral health care. Time is a significant barrier for the utilization of dental services. The programs designed to address barriers to oral health care utilization for children should be geared towards overcoming the possible threats that socio-economic status and type of parents they have may pose, to reduce inequity in dental service utilization.