Is parental oral health literacy a predictor of children's oral health outcomes? Systematic review of the literature

Development and psychometric validation of a novel health literacy scale for family caregivers of preschool children

BACKGROUND

Health literacy among family caregivers has been found to be strongly correlated with health exposures and outcomes for their children. Accurate assessment of their health literacy contributes to improving child health outcomes. Given the limited evidence on health literacy measures for family caregivers, the study aimed to develop and validate a novel Health Literacy Scale for Family Caregivers of Preschool Children (HLSFC).

METHODS

The HLSFC was developed in 4 phases: 1) using Nutbeam's conceptual framework of health literacy as a guide to clarify the content to be measured; 2) generating an item pool; 3) providing feedback on the initial items; 4) psychometric analyses. A cross-sectional survey of 443 family caregivers of preschoolers was conducted in Northwest China. Construct validity was assessed using exploratory factor analysis (n = 213) and confirmatory factor analysis (n = 230). Reliability was assessed using internal consistency, split-half reliability, and test-retest reliability.

RESULTS

Thirty-Three items were included in the final instrument. Principal component analysis yielded a three-factor structure explaining 70.013% of the total variance. All fitting indices met the standard based upon confirmatory factor analysis. The composite reliability values of the factors ranged from 0.928 to 0.944 (> 0.7), and the average variance extracted values ranged from 0.552 to 0.590 (> 0.5), indicating acceptable convergent validity. The Cronbach's alpha value was 0.963. The test-retest reliability was good, with an intraclass correlation coefficient of 0.909. Sociodemographic factors, such as caregiver education, occupation, residence, and monthly household income per person, were significantly associated with health literacy scores.

CONCLUSION

The HLSFC demonstrated adequate reliability and validity, and can measure a wide range of health literacy skills: from functional to interactive and critical health literacy. It could be potentially applied as an effective tool for the health literacy assessment among family caregivers of preschoolers.

Health and oral health literacy: A comprehensive literature review from theory to practice

BACKGROUND

Health literacy (HL) refers to an individual's ability to access, understand, and apply health information to make informed decisions about their health. On the contrary, oral health literacy (OHL) focuses on an individual's ability to understand and utilize oral health information to maintain good oral health.

AIM

This study presents a comprehensive literature review that explores the theoretical foundations and practical applications of HL and OHL.

DESIGN

A comprehensive search was conducted using keywords on the following databases: PubMed, Google Scholar, and Cochrane Database of Systematic Reviews.

RESULTS

The existing literature on various aspects of HL, including the most common used definitions of HL, conceptual frameworks, and consequences of limited health and OHL, was summarized. Additionally, the review discussed the significance of HL and OHL. Also, the relation between parent level of OHL and children's oral health was described. It further highlights modern approaches that have been shown in previous studies to improve the OHL of primary caregivers.

CONCLUSIONS

Understanding the significance of HL and OHL is crucial in developing effective interventions that can address disparities and improve oral health outcomes for individuals of all backgrounds.

Effectiveness of a message service on child oral health practice via a social media application: A randomized controlled trial

BACKGROUND

Early establishment of healthy oral health behaviours is important to reduce early childhood caries risk. Two-way social media applications can economically assist caregivers.

AIM

To evaluate the effectiveness of a LINE™ messaging service (MS) on promoting good oral health behaviors in Thai children.

DESIGN

One hundred and ninety caregiver-child dyads (children aged 6-36 months) who attended a university dental hospital and two other hospitals were randomly assigned to receive age-appropriate dental health education via MS or through traditional on-site visits. Infographic posters, video clips, and supportive messages were delivered weekly to the MS group. Parental oral health knowledge and children's oral health status and practice were assessed at baseline and 6-month follow-up.

RESULTS

The MS group showed significantly better scores in feeding habits (p = .034) and toothbrushing practice (p = .007). Parental knowledge increased in both groups; however, knowledge increased significantly in the control group (p = .001). Both groups exhibited improvements in the debris score but not in caries progression. The caregivers rated both methods as high to the highest satisfaction.

CONCLUSIONS

The MS yielded comparable outcomes to traditional dental visits in promoting oral health behaviours.

Exploring the Link Between Maternal Oral Health Literacy and Child Oral Health Behaviours

INTRODUCTION AND AIMS

Caregiver's oral health literacy (OHL) has a multidimensional impact on child oral health outcomes. In infants and toddlers, oral health behaviours (OHB) play a crucial role in the development of early childhood caries and could be related to the caregiver's OHL. A simple OHL assessment may help identify children at risk of caries. This study aimed to investigate the association between maternal OHL and the child OHBs during the first 2 years of life.

METHODS

A cross-sectional study was conducted with 398 mothers of children aged 6 to 24 months. Maternal OHL was assessed using the ThREALD-30. Maternal demographics, oral health knowledge, and child OHBs were collected through self-administered questionnaires. ThREALD-30 scores were compared using the Mann-Whitney U and Kruskal-Wallis tests. Spearman's rank correlation and gamma generalized linear models were used to identify factors associated with OHL. Binary logistic regression examined the association between maternal OHL and child OHBs. The Receiver Operating Characteristics curve determined a cut-off OHL score for severely deleterious child OHBs, and Chi-square analyses assessed the association with the cut-off.

RESULTS

The mean maternal ThREALD-30 was 23.7 (SD = 5.0), showing a strong positive correlation with oral health knowledge (r = 0.81, P < .001) and associations with low education and family income (P < .001). Logistic regression showed that lower ThREALD-30 levels were associated with poor child OHBs, including nighttime feeding, sugary bottle feeding, and no oral cleaning (P < .05). ThREALD-30 score ≤21 related to severely deleterious child OHBs.

CONCLUSION

Lower maternal OHL was strongly associated with poor child OHBs, with a ThREALD-30 score ≤21 indicating a high risk of caries.

CLINICAL RELEVANCE

ThREALD-30 may be a useful screening tool for assessing mothers with young children at risk of early childhood caries.

Parental and individual determinants of dental trust in children: a path analysis of a conceptual model

BACKGROUND

Understanding the interactions among predictors of dental trust in children is important for designing effective interventions in pediatric dental care.

AIM

This study aimed to develop and validate a conceptual model to evaluate factors influencing dental trust in children.

DESIGN

This cross-sectional study included 267 parent-child dyads. Data collection tools included a sociodemographic data form, the Turkish Oral Health Literacy Assessment Task (TOHLAT-P), the Dental Trust Scale (DTS), the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS), and the Early Childhood Oral Health Impact Scale (ECOHIS). The conceptual model explored the factors influencing dental trust in children by incorporating endogenous and exogenous variables. Path analysis was conducted to test model fit.

RESULTS

Dental trust was significantly associated with parental oral health literacy (β = -0.20; P < 0.001), dental anxiety (β = -0.18; P < 0.001), and oral health-related quality of life (β = -0.15; P < 0.001). The path analysis confirmed the validity of the proposed model, showing significant pathways between these variables and dental trust in children.

CONCLUSIONS

This study presents a validated model illustrating the relationships between parental and child-related factors and dental trust in children. These findings underscore the importance of addressing these factors in clinical strategies to enhance dental trust and improve pediatric dental outcomes.

Family factors associated with dental caries among 5-year-old preschool children

Background

Although dental caries is largely preventable, it remains highly prevalent among children.

Aim

Evaluate family factors associated with the prevalence of dental caries in 5-year-old children.

Design

This cross-sectional study recruited 5-year-old children from public preschools in Araraquara, São Paulo, Brazil. Data on sociodemographic factors, family routines, and oral health practices were gathered via a self-administered questionnaire completed independently by caregivers. Children received a dental clinical examination at school and caries experience was recorded using the dmft and SiC (Significant Caries index) indexes following the World Health Organization (WHO) criteria.

Results

Data analysis was performed using Chi-square and multiple logistic regression using a significance level of 5%. Of the 578 children in the study, 67.3% were caries-free. The mean dmft index was 1.14 (SD = 2.24), while the SiC index stood at 3.46 (2.69). Factors such as income, caregiver assistance with toothbrushing, caregiver perception of child and parent oral health, and prioritization of dental visits within the family were associated with caries presence.

Conclusions

Overall, dental caries prevalence was low in this population, with family factors demonstrating significant associations with dental caries. The attitudes of caregivers regarding oral health appear to wield considerable influence over the dental health of their children.

Motivational interviewing at home: A community trial to improve oral health literacy and reduce morbidity in disadvantaged Chilean families

BACKGROUND

Limited evidence exists regarding the effects of home-based interventions on oral health outcomes in preschool-aged children or caregivers despite the success of such interventions in other child and pregnancy health outcomes. The aim of this community trial was to assess the impact after 12 months of a home-delivered motivational interviewing (MI) intervention on oral health outcomes in disadvantaged Chilean families.

METHODS

This trial was conducted with a community single-blinded design, including preschoolers (aged 2-4 years) and their caregivers from 2 disadvantaged communities who received either the MI intervention or standard oral health interventions at kindergartens. The MI intervention comprised from 4 through 6 tailored home visits by MI-trained dental hygienists. Data on socioeconomic-demographic factors, caries (International Caries Detection and Assessment System [ICDAS]), oral hygiene, and caregivers' oral health literacy (OHL) (assessed with Oral Health Literacy Instrument and Rapid Estimate of Adult Literacy in Dentistry, 30 items) were collected at baseline and 12-month follow-up.

RESULTS

Two hundred fifty-two dyads completed baseline measurements, and 212 completed the follow-up (control, n = 104; intervention, n = 108). Weak associations were found between clinical-sociodemographic factors and OHL at baseline (correlations, < 0.3) and follow-up. Analysis of covariance revealed a reduction in caries incidence for lesions with ICDAS scores above 0 (P = .03) but not for ICDAS scores above 2 (P = .47). No reduction in oral hygiene was observed (P = .74). Oral Health Literacy Instrument scores showed no improvement (P = .10), and Rapid Estimate of Adult Literacy in Dentistry, 30 items scores showed a marginal increase (P = .03).

CONCLUSIONS

Home-delivered MI intervention had a marginal impact on preschoolers' caries incidence and caregivers' OHL but no effect on preschoolers' oral hygiene, with the primary impact observed at the level of caries ICDAS scores above 0.

PRACTICAL IMPLICATIONS

Home-delivered MI interventions by dental hygienists marginally reduce caries incidence in preschoolers from disadvantaged populations. This trial was registered at the Australian and New Zealand Clinical Trials Registry. The registration number is ACTRN12615000450516.

The impact of parental dental anxiety and oral health literacy on child oral health and dental-visit patterns: a cross-sectional study

BACKGROUND

Identifying the risk indicators of parental dental anxiety (PDA) and oral health literacy (OHL) can help oral healthcare professionals recognise challenges in this field. Armed with the appropriate information, they can effectively engage with parents to build trust and promote early and regular child dental visits.

OBJECTIVES

This study aimed to investigate the association between PDA and OHL with the sociobehavioural characteristics of families, self-reported child oral health (presence of ≥ 1 untreated decayed teeth) and the dental visit patterns amongst children living in Al Jouf Province, Kingdom of Saudi Arabia.

SUBJECTS AND METHODS

A total of 430 parents with children aged ≥ 14 years were invited using a systematic random sampling method. PDA was assessed using the Dental Anxiety Scale-Revised (DAS-R) scale, and parents' OHL was measured using the Rapid Estimate of Adult Literacy in Dentistry-30 (REALD-30). The relationships amongst participant characteristics, PDA and OHL were evaluated through the Chi-square and ANOVA. Additionally, binary regression analysis was conducted to identify predictor variables associated with PDA and OHL. A P value of < 0.05 was considered statistically significant.

RESULTS

Children with ≥ 1 untreated decayed tooth were 2.5 times more likely to have PDA (95% confidence interval [CI] = 1.37, 4.37). Children who visited the dentist in < 6 months had 93% lower likelihood to have PDA (adjusted odds ratio (AOR) = 0.07; 95% CI = 0.03, 0.18). Parents aged 20-25 years were 81% less likely to have OHL than those above 30 years (AOR = 0.19; P = 0.038). Similarly, parents with medium family income were 52% less likely to have OHL than the high-income group (AOR = 0.48; P = 0.013). Finally, parents of children who visited the dentist within < 6 months were 34 times more likely to have OHL than those whose children visited the dentist > 12 months ago (AOR = 34.94; P < 0.001).

CONCLUSION

PDA and OHL were significantly affected by parental age, family income, the presence of ≥ 1 untreated decaying tooth and the child dental visit patterns. During a child's first dental visit, paediatric dentists should always assess the PDA, OHL and sociobehavioural characteristics of a family by using appropriate scales and semistructured interviews.

Parental Reports of Children's Dental Pain Experience and Associated Factors among Brazilian Children

Exploring children's dental pain experiences helps to develop healthcare policies for improving oral health and quality of life. A cross-sectional study involved 300 parents/caregivers of four- to seven-year-old children using snowball sampling. Parents/caregivers self-completed an online questionnaire on sociodemographic characteristics, parenting styles, their child's oral hygiene practices, free sugar consumption, and dental history. The questionnaire was created using Google Forms and was disseminated to parents/caregivers via E-mail and/or WhatsApp©. Descriptive and Poisson regression analyses were performed (p < 0.05). Children's dental pain experience was reported by 20.3% of the parents. The authoritative parenting style was predominant. The child's mean age at the first consumption of sugar was 1.38 (±0.64) years, and 40.3% of the children had high-free sugar consumption. The mean age for the first dental appointment was 2.26 (±1.31) years, and 24.3% of the children never went to a dental appointment. The prevalence of dental pain experience was higher in children who attended their first dental appointment later (PR: 1.02; CI 95%: 1.01-1.03) and among those with high-free sugar consumption (PR: 1.90; CI 95%: 1.21-3.00). High sugar consumption and delay in the first dental appointment may increase the likelihood that children will experience dental pain.

A Right to Health-Based Approach to Dental Caries: Toward a Comprehensive Control Strategy

BACKGROUND

Health is a matter of human rights, and dental caries is the most common noncommunicable disease globally. Consequently, dental caries is a matter of human rights and its control, particularly prevention, must be a priority. Although largely preventable, this is too often neglected, both in the literature of human rights and health law, and in dental research. The right to oral health has recently been acknowledged by the World Health Organization (WHO), but it is insufficiently clear what this right entails.

SUMMARY

This article introduces a right to health-based narrative in the context of dental caries. The right to health is stipulated in human rights treaties, including the International Covenant on Economic, Social and Cultural Rights (ICESCR) and the Convention on the Rights of the Child (CRC). States that are parties to these treaties, which are virtually all States globally, are mandated to ensure the enjoyment of individuals' right to the highest attainable standard of health, including oral health.

KEY MESSAGES

Dental caries is a matter of human rights. States have binding obligations to address dental caries: they require the regulation of the healthcare system, i.e., the traditional focus on operative care, but also put the regulation of other risk factors on an equal footing, such as the regulation of the living environment and access to fluoride. A right to health-based approach to dental caries thus offers a comprehensive approach to dental caries control, particularly prevention.

Oral health literacy among migrant mothers in Sweden. A qualitative study

OBJECTIVE

This interview study explored the oral health literacy of migrant mothers in Sweden, with special reference to where and why they access information about oral health and how they determine the credibility of such information.

MATERIAL AND METHOD

In-depth interviews were conducted with seven migrant mothers of children up to 10 years old. The mothers had entered Sweden from 2015 onwards and had been resettled in Kalmar County, Sweden. Their native language was Somalian, Dari or Arabic. The interview questions concerned the participants' experiences of seeking oral health information, as well as oral health in general and dental health services. The interviews were analysed by qualitative content analysis.

FINDINGS

The main findings indicate that migrant mothers used information sourcing as a pathway to solve oral health literacy tasks. Three main categories were identified, each with subcategories, describing the migrant mothers' experiences of accessing and evaluating oral health information: 'accessible source of information', 'needs-related purpose of seeking information' and 'trustworthiness assessment'. The migrant mothers reported that in case of a dental emergency or general queries, they sought oral health information from professionals and social sources. Moreover, they perceived oral health information to be most reliable when it was provided by dental professionals, was a recurring theme, or constituted majority opinion.

CONCLUSION

To improve oral health literacy in migrant mothers of young children, it is important not only to provide consistent and recurrent oral health information through accessible information channels, but also to adapt dental care to be more culturally appropriate.

Child oral health: A plea for interdisciplinarity

A child’s oral health has major implications both for their general health and for their quality of life. Even before birth, the mother’s oral health can affect the development of the baby and pregnancy outcomes. From the very first months of life, feeding habits together with non-nutritive sucking ones, early transmission of pathogenic bacteria, and oral hygiene practices prefigure the child’s future health. The aim of this article is to provide a comprehensive overview of our current knowledge regarding the main oral health issues affecting children, namely dental caries, erosive tooth wear, developmental defects of enamel, maxillofacial growth anomalies, and traumatic dental injuries. Additionally, it aims to examine the oral health prevention and promotion programs that have been implemented in France over several decades. These prevention and promotion initiatives are not only part of a national program but are also being organized at a territorial level, although, unfortunately, they often remain limited to regional, departmental, or municipal scopes. It is essential for all those involved with children, whether they are health care professionals or not, to collaborate effectively to enhance both oral health and overall well-being. This requires fostering an interdisciplinary approach that involves various contributors working together in a complementary way.

Parental oral health literacy influences preschool children's utilization of dental services

Parental behavior towards their children's oral health is strongly influenced by parent's Oral Health Literacy (OHL) level. This study evaluated the impact of parental OHL on preschool children's utilization of dental services. A cross-sectional study was conducted with parents of 419 children aged 3 to 5 years who answered a self-administered questionnaire about their perception of their children's oral health and whether their children had already been to a dental visit. Parental OHL level was assessed by the validated version of the Oral Health Literacy Adult Questionnaire (OHL-AQ) translated into Brazilian Portuguese. Univariate and multivariate Poisson regression analyses with robust variance were used for the data analysis (α = 0.05). Most children had already been to a dental visit (73%). Overall, 31.7% of the parents or guardians reported that their children had experienced dental pain or dental caries. Parental OHL level was classified by tercile as low, medium, and high. The final model showed independent associations between children who had already been to a dental visit and higher parental OHL level (PR = 1.16; 95%CI = 1.00-1.35) when compared to the lowest OHL level, higher parental educational level (PR = 1.39; 95%CI = 1.03-1.87) when compared to lower educational level, the report of children's pain and dental caries (PR = 1.22; 95%CI = 1.09-1.36) and married parents or parents in a common-law marriage (PR = 1.17; 95%CI = 1.03-1.93). The prevalence of children who had already been to a dental visit was higher among those parents with a higher OHL level when compared to those with a lower OHL level.

Parent's Attitudes toward Their Children's Oral Health Care during the COVID-19 Pandemic: A Cross-Sectional Study

Background

The COVID-19 pandemic has significantly impacted global health and presented challenges to maintaining oral health in children. Efficient management and prevention of oral diseases are therefore crucial in this population.

Aim

This cross-sectional study aimed to assess parents' self-reported oral and dental hygiene habits for their children during the COVID-19 pandemic.

Methods

A total of 256 parents of primary school children in Qazvin completed an online questionnaire containing demographic, general, and cardinal questions. The collected data were analyzed using SPSS 22 software, and accurate analytical tests were run to reach the results.

Results

The study found that 69.1% of parents and 87.1% of children brushed their teeth regularly during the pandemic. Additionally, 80.5% of parents monitored their children while brushing. While some parents expressed concerns about COVID-19 infection, parents from lower socioeconomic status reported a higher willingness to attend dental centers than those from more prosperous areas.

Conclusion

These findings suggest that parents' supervision and attitude toward oral health care significantly affect children's oral hygiene habits during the pandemic, possibly due to increased time spent together during lockdowns.

Barriers and facilitators to dental care among culturally and linguistically diverse carers: A mixed-methods systematic review

OBJECTIVES

Culturally and linguistically diverse (CALD) communities experience widespread inequalities in dental care utilization. While, several studies have reported factors contributing to such inequalities, a synthesis of evidence is lacking for CALD carers. This review examined the barriers and facilitators to dental care utilization among CALD carers.

METHODS

Medline, CINAHL, ProQuest, Scopus and Web of Science were searched for dental utilization and related factors, without geographic limitations. An integrated mixed-method design was adopted, where both qualitative and quantitative findings were combined into a single synthesis. Critical appraisal was conducted using JBI tools, and a Universal Health Coverage (UHC) framework guided the synthesis approach. Reliability and researcher triangulation occurred throughout the conduct of this review.

RESULTS

A total of 20 papers were included: qualitative (n = 8), quantitative (n = 8) and mixed method (n = 4). Studies were from Australia, Canada, South Korea, Trinidad and Tobago, United Kingdom and the United States. Three studies insufficiently reported confounding variables and nine qualitative papers lacked philosophical perspectives. Affordability was the foremost barrier at the system level, followed by psychosocial negative provider experiences and language/communication issues at the provider level. Cultural, knowledge, attitudes and beliefs were individual-family level factors. Utilizing a UHC framework, the barriers and facilitators were aggregated at three levels; financial-system, provider and individual-family levels and illustrated in the rainbow model of CALD oral health.

CONCLUSION

The review strengthens evidence for multilayered, system-related policies and culturally sensitive provision of services for reducing oral healthcare inequalities in CALD carers.

What is the influence of oral health literacy on the parents' choice of fluoride toothpaste?

DESIGN

Investigator blind randomised controlled trial.

INTERVENTION

One hundred and forty-five parents or carers of children up to four years of age were recruited from families attending a clinic for premature children in Brazil. The aim was to assess the influence of Oral Health Literacy (OHL/OHL-AQ) on the effective and safe use of fluoride toothpaste. The participants were stratified into adequate (12-17) and marginal/inadequate OHL (0-11) and randomly allocated into one of four intervention groups as follows, based on how information was provided: 1. written, 2. oral, 3. written & photograph, 4. oral & photograph. Socioeconomic status was also recorded. Prior to the intervention, the participant's ability to apply the correct amount of toothpaste (1000 p.p.m F^-) was assessed.

DATA ANALYSIS

Data were analysed using the t-test and one-way ANOVA. The chi-squared test was used to evaluate associations between participants' ability to select the correct toothpaste, sociodemographic characteristics, oral health habits and OHL.

RESULTS

The majority of the sample were female (89%), with the whole sample's mean age being 31.9 ± 8.3 years. The OHL-AQ score ranged from 2-16 (mean: 11.3 ± 3.0). Before or after the intervention, having a higher level of OHL was associated with a tendency to deliver the more correct amount of toothpaste onto the brush. The interventions did lead to an improvement in the volume of toothpaste used across all groups. Only schooling was associated with the correct choice of toothpaste.

CONCLUSIONS

Parents or guardians with higher OHL used less, and consequently more ideal amounts of, fluoride toothpaste for children compared to those with a lower level of OHL. This was the case both before and after the educational interventions. The allocation to intervention group did not predict the amount of toothpaste used. Finally, only schooling predicted the choice of correct fluoride toothpaste.

Dental Caries Experience in Children in Public Kindergartens of Sarajevo, Bosnia and Herzegovina

OBJECTIVES

Dental caries first occurs within primary dentition in toddlers and preschool children, in a form of early childhood caries (ECC). In every day's busy and employment burdened parenting, caretakers and institutions have become important even more nowadays, not only for forming child general behavior and character, but also for maintenance of their general and oral health as well.

AIMS

To evaluate the presence and severity of ECC in children who attended public kindergartens in Sarajevo, and to offer basic information for the maintenance and improvement of child oral health to their parents and kindergarten teachers.

METHODS

The study included 1722 preschool children aged 3-6 years who attended kindergartens within Sarajevo public kindergarten institution, together with their parents and kindergarten teachers. Dental team members gradually visited all kindergartens situated in four Sarajevo city municipalities and examined kindergarten children according to the WHO Oral Health Survey Manual. Oral health promotion material for parents and kindergarten teachers was also distributed simultaneously during sequential visits.

RESULTS

ECC was present in preschool kindergarten children in Sarajevo, with its high prevalence (67.71%); dmft-value (3.97) and severity (SiC index 8.79). There was also a significant lack of dental healthcare to examined children mostly related to lack of visiting dental offices by children's parents (CI=10.55%, RI=10.80%, TI=12.98%).

CONCLUSION

Parental role in preserving and improving of their children oral health should be systematically and profoundly improved. Kindergarten officials and staff should recognize the importance of anticariogenic diet menus and oral hygiene maintenance within their institutions.

Reliability and validity of the Turkish version of the Oral Health Literacy Assessment Task: Pathways between parental oral health literacy and oral health consequences in children

BACKGROUND

Parental oral health literacy (OHL) is a determinant of oral health behavior and oral health status of children.

AIM

To delineate the pathways between parental OHL and oral health consequences in children and to validate the Turkish version of the Oral Health Literacy Assessment Task (TOHLAT-P).

DESIGN

This cross-sectional study was conducted with 315 parent-child dyads. The TOHLAT-P was psychometrically evaluated. Item analysis was performed to determine the reliability of the TOHLAT-P. Construct validity was tested by comparing a commonly used instrument using Pearson's product-moment correlation coefficients. A path model was developed to evaluate associations between parental OHL and oral health consequences in children. The model consisted of five endogenous variables (parental oral health behaviors, children's oral health behaviors, children's dental anxiety, dental caries, and oral health-related quality of life [OHRQoL]) and one exogenous variable (parental OHL). A path analysis was used to test the compatibility of the conceptual model, with a statistical significance of p < .001.

RESULTS

There was a statistically significant association between parental oral health behaviors and children's oral health behaviors, and between dental caries and OHRQoL. The variable most directly affected by parental OHL was parental oral health behaviors, whereas the variable most indirectly affected by parental OHL was children's oral health behaviors.

CONCLUSIONS

The path analysis revealed significant associations between parental and children's oral health behaviors, and between dental caries and OHRQoL. Understanding these pathways is necessary to establish strategies to improve children's oral health. The TOHLAT-P will be useful for future assessments of Turkish children.

Factors associated with the use of oral health services in Peruvian children under the age of 12 years

OBJECTIVES

To determine the prevalence and factors associated with the use of oral health services in Peruvian children under 12 years of age.

MATERIAL AND METHODS

A secondary analysis of 2019 Demographic and Family Health Survey was conducted. The sample consisted of 40,751 children. The main variable was the use of dental services (attended/not attended) in the last 6 months, and the independent variables were gender, age, area of residence, wealth quintile, health insurance coverage, information received on oral health care, age, and educational level of the caregivers. Analyses of absolute and relative frequencies, differences in proportions, and multivariate analysis using generalized linear models were performed.

RESULTS

The dental service utilization prevalence during the last 6 months was 31%. Correlation was found with urban area residents (PRa = 0.945; 95% CI: 0.904-0.988), the Jungle geographical domain (PRa = 0.926; 95% CI: 0.877-0.977), the highest wealth quintile (PRa = 1.323; 95% CI: 1.232-1.421), the higher education level of the caregiver (PRa = 1.375; 95% CI: 1.231-1.536), affiliation with the Public Health Insurance (PRa = 1.112; 95% CI: 1.069-1.158), and the condition of having received information on oral health care (PRa = 2.355; 95% CI: 2.263-2.245) with respect to their baseline variables.

CONCLUSIONS

Several socio-demographic factors were correlated with the use of oral health services in Peruvian children under 12 years of age and the percentage of their use was low. Information on oral health care had a more significant impact on both, the population from the highest wealth quintile and the highest educational attainment.

Development of Mothers' Health Literacy: Findings From the KUNO-Kids Study

BACKGROUND AND OBJECTIVE

The aim of this study was to analyze the longitudinal development of health literacy (HL) in a large cohort of new mothers in Germany and to investigate which determinants are associated with the initial HL level and with change over time.

METHODS

Longitudinal data from 1,363 mothers participating with their child in the KUNO-Kids Health Study was used; data were collected at birth of the child (baseline), after 6 and 12 months, using interviews and self-report questionnaires. The HL of mothers was assessed with the health care scale of the European Health Literacy Survey Questionnaire, which has 16 items on accessing, understanding, appraising, and applying health information in the health care setting. Latent growth curve models were used to analyze average trajectories and predictors of HL in the total sample and in the subgroup of first-time mothers.

KEY RESULTS

HL values increased from baseline (M = 35.46, standard deviation [SD] = 7.34) over 6 months (M = 37.31, SD = 7.31) to 12 months (M = 38.01, SD = 7.41). The increase was statistically significant in the total sample (1.188, standard error [SE] = 0.087, p < .001) and in the subgroup of first-time mothers (1.357, SE = 0.113, p <. 001), with a steeper trajectory for mothers with lower HL at baseline. Several personal and situational variables were associated with HL at baseline (e.g., education, child health) and with its development (e.g., number of children).

CONCLUSION

Overall, new mothers became slightly more health literate during their child's first year of life. However, some groups of mothers could benefit from support in developing HL skills even before childbirth. [HLRP: Health Literacy Research and Practice. 2023;7(1):e39-e51.] Plain Language Summary: We investigated how health literacy (that is the ability to find, understand, and apply health information) develops in new mothers in Germany. Mothers told us that this ability slightly improved during the child's first year of life. Some mothers still have difficulties in dealing with health information; these mothers should be supported even before childbirth.

Validity and Reliability of the Parental Health Literacy Questionnaire for Caregivers of Children Aged 0 to 3 Years in China

Caregivers' health literacy plays a vital role in the quality of parenting and significantly impacts children's physical and psychological health. However, the instruments to assess the health literacy of caregivers of children aged 0 to 3 years are lacking. This study aimed to evaluate the reliability and validity of the Chinese Parental Health Literacy Questionnaire (CPHLQ) in China. We conducted a cross-sectional study. Six hundred and thirty-four caregivers of children aged 0 to 3 years were recruited from Shandong, Yunnan, and Shaanxi Provinces, representing the eastern, central, and western regions of China, between November 2020 and January 2021. The reliability was evaluated by internal consistency reliability and split-half reliability. The construct validity was determined by confirmatory factor analysis. Social determinants of parental health literacy were assessed by multivariate linear regression model. Results showed that CPHLQ had satisfactory reliability and acceptable construct validity. Mothers compared to other types of caregivers, higher education levels, and nuclear or extended families compared to other family compositions were significantly associated with higher parental health literacy. The study further demonstrated that CPHLQ is a reliable and valid instrument to measure the health literacy of caregivers of children aged 0 to 3 years in the Chinese population. It can be used as an evaluation tool for intervention research, to inform policy-making and future health education interventions of improving caregivers' health literacy.

Understanding dental caries as a non-communicable and behavioral disease: Management implications

New paradigms in caries conceptualization have emerged during the last decades, leading to intense debate and discussion on how to approach the disease, both from a preventive and a therapeutic perspective. Among many new ideas, research discoveries and technologies, one major concept can be highlighted that created a deep frontier between the old and the new paradigm in caries conceptualization; the non-communicable nature of the disease, firmly associated with behaviors and lifestyles. This article synthetizes the conceptual construction of dental caries as a non-communicable disease (NCD) based on the current evidence and discusses the appropriate management of the disease in this context. Dental caries has shifted from being considered transmissible and infectious to an ecological and non-communicable disease. Environmental factors such as frequent sugars intake, disrupt the symbiosis of the dental biofilm leading to a dysbiosis, which favors caries lesion initiation and progression. As an NCD, dental caries shares characteristics with other NCDs such as cardiovascular and chronic respiratory diseases, cancer and diabetes, including long duration and slow progression, not being transmissible from person-to-person, being strongly related to modifiable behavioral risk factors, and affecting preferentially disadvantaged populations with a strong inequality gradient. Given the high prevalence of dental caries, and its consequences on people's health and quality of life, a recognizable conceptual view of caries as a NCD is required to target an effective management. Current understanding of dental caries supports prevention through acting on the modifiable risk factors (behaviors) and involves management based on an interdisciplinary approach. Communicating these modern concepts among researchers, clinicians and policymakers is needed to decrease the global high burden of the disease.

Impact of a Dental Storybook on Parents' Knowledge of Children's Oral Health: A Randomized Controlled Trial

Purpose

To evaluate the effectiveness of a dental storybook on parents' knowledge about oral health of their children and to assess their perception of its effect in reducing dental anxiety levels among their children, as well as improving their oral health knowledge.

Patients and Methods

This was a two-arm parallel, single-blind, randomized controlled trial (RCT) which was performed at the pediatric dental clinics in the Dental University Hospital, King Saud University, Riyadh, Saudi Arabia. Parents of 88 children (6-8 years old) were included in the present study. Parents and their children were randomly divided into two groups as follows: the intervention group (received the storybook and verbal oral hygiene instructions) and the control group (only received verbal oral hygiene instructions; same information included in the book). Three dental visits, including screening, examination/cleaning and treatment, were provided for each child. In the screening visit, baseline parental oral health knowledge was evaluated for all parents. Afterward, parental oral health knowledge was re-evaluated in the examination visit. In the treatment visit, a parental perception questionnaire was administered to parents following treatment to evaluate their satisfaction regarding the use of the storybook in reducing anxiety levels among their children.

Results

There was a significant improvement in the total knowledge score at the follow-up visit in the intervention group compared to the control group (P<0.0001). Overall, the majority of parents perceived the storybook as a useful source of information, and they found it to be effective in reducing dental anxiety levels among their children.

Conclusion

The dental storybook is an effective educational tool that can help parents become more knowledgeable about their children's oral health. Moreover, parents perceived the storybook as an effective tool for enhancing their oral health knowledge and lowering their children's dental anxiety.

Characteristics of oral health literacy in Senegal: A cross-sectional study among women in the Department of Pikine

Senegal having a significant prevalence of socially differentiated oral diseases, oral health literacy (OHL), an individual and social resource, should be considered alongside a remedial response. This work aimed to analyze women’s OHL characteristics. A cross-sectional study on 315 women in Pikine County was carried out, using the Oral Health Literacy-Adult Questionnaire (OHL-AQ) for the OHL data collection and a questionnaire for the women’s socioeconomic characteristics data. These women had an OHL average score of 6.5±3.1 and a median of 6. Among them, 56.5% had a seemingly low OHL level, a little over 68.9% had a score above the median as regards the “listening, communication and understanding” aspect, 58.4% to “decision making”, 55.2% to “understanding numbers” and 33% to “reading and understanding”. According to a multivariate analysis, secondary and higher educated women (p<0.001) with an active social network (p<0.023), in a wealthy household (p<0.0001) and of nuclear household type (p<0.036) had a higher OHL level. Women in Pikine have low OHL and are from working- class households. Therefore, oral health policies must take into account the women’s social network contribution to the OHL improvement.

Impact of Parents' Oral Health Literacy on Their Own and Their Children's Oral Health in Chinese Population

Background

Oral health literacy (OHL) has been recognized as a component of oral health disparities; however, the precise relationship between literacy and oral health outcomes has not been established. To explore the role of parents' OHL for their own subjective oral health, related behavior, and for the proxy assessment of their child's oral health, oral health-related behavior.

Methods

Survey data were collected from 406 parents of 4- to 7-year-old children in Beijing, China. The background characteristics, oral health assessment, oral health-related behavior, knowledge and attitudes, and diet-related questions of parents and their children were surveyed by a questionnaire. OHL was assessed with the Hong Kong Rapid Estimate of Adult Literacy in Dentistry (HKREAL-30) Scale and a revised version that asked the respondents to indicate if they understood the words (HKREALD-30-Understand).

Results

The HKREALD-30 responses correlated with the HKREALD-30-Understand responses. The higher the parents' HKREALD-30-Understand scores, the better they described the health of their own teeth and gums, the greater their child's diet was influenced by the protein, sugar and calories of the food, and the more positive their oral health-related attitudes were. The higher the parent's HKREALD-30 scores, the healthier they described their child's teeth and gums.

Conclusions

Both the HKREALD-30 and HKREALD-30-Understand Scores correlate with parents' self and proxy oral health-related responses. Chinese parents could understand that the word would add predictive value to the prediction of how parents' oral health literacy affects their own oral health care, children's oral health and other related aspects.

Development and Validation of an Oral Health Literacy Measurement for Primary School Children in Thailand

Background

Oral health promotion programs have been implemented in primary schools for many years in Thailand. Oral health literacy has been introduced as a health promotion outcome; however, no assessment tool has been developed for this age group. The objective of this study was to develop and validate the Test of Functional Health Literacy in Dentistry for Primary School Children (P-TOFHLiD). Materials and Methods. The P-TOFHLiD was developed by modifying contents and outlines using a previously validated tool for older adults, then verified by two experts for face validity. A cross-sectional study was conducted with samples collected from 118 grade-six students from two government schools in Chiang Mai Province, Thailand. The P-TOFHLiD and a previously validated word recognition test were administered, followed by oral examination to assess reliability, concurrent validity, convergent validity, and predictive validity and establish the cut-off score of the tool. The statistical analysis was performed using SPSS version 25.

Results

The internal reliability of P-TOFHLiD was good (α = 0.808). The correlation coefficient between the P-TOFHLiD and grade point average was 0.478 (p value <0.001), which is the represented concurrent validity of the tool. Coefficients between P-TOFHLiD and a word recognition test was 0.422 (p-value <0.001) for convergent validity. P-TOFHLiD was significantly correlated with the number of missing teeth from tooth decay (p-value <0.05), but the correlation coefficient was poor (r = −0.100). The cut-off scores for adequate oral health literacy were set at ≥21 out of the total scores of 26.

Conclusion

P-TOFHLiD presented good validity and reliability and was ready to use for oral health promotion program evaluation. However, the predictive validity of the P-TOFHLiD in predicting oral health status was questionable only.

Attention-deficit Disorder, Family Factors, and Oral Health Literacy

Introduction

Relationships amongst attention-deficit/hyperactivity disorder (ADHD), family factors, and oral health literacy (OHL) in adolescents are unclear. The objective of this research was to investigate whether family environment and signs of ADHD are associated with OHL at the onset of adolescence.

Methods

A cross-sectional study was performed with 448 twelve-year-old adolescents enrolled in schools in Cajazeiras, Brazil. Adolescents responded to an instrument measuring OHL (Brazilian version of the Rapid Estimate of Adult Literacy in Dentistry [BREALD-30]) and a validated questionnaire addressing family cohesion and adaptability (Family Adaptability and Cohesion Scales [FACES III]). Parents and teachers answered subscales of the Swanson, Nolan, and Pelham Questionnaire (SNAP-IV) and a socioeconomic questionnaire. Adjusted Poisson regression analysis was employed for the data analysis (P < .05).

Results

Greater OHL was found in adolescents with higher family cohesion scores (rate ratio [RR], 1.02; 95% confidence interval [CI], 1.01–1.03), those whose mothers had more than 8 years of schooling (RR, 1.07; 95% CI, 1.03–1.12), and those whose families earned more than the Brazilian minimum salary (RR, 1.08; 95% CI, 1.03–1.12). Higher family adaptability scores (RR, 0.99; 95% CI, 0.98–0.99) and more signs of ADHD (teachers’ reports) (RR, 0.95; 95% CI, 0.91–0.99) were associated with lower OHL.

Conclusions

OHL in adolescents was influenced by family adaptability and cohesion, signs of ADHD, maternal schooling, and family income.

Contextual and individual factors associated with oral health literacy in adolescents: A multi-level approach

This study aimed to evaluate the association of contextual and individual factors with Oral Health literacy (OHL) in early adolescence. This is a population-based cross-sectional study carried out with 740 12-year-old adolescents randomly selected by a two-stage probabilistic cluster sampling process from schools in Campina Grande, Brazil. The guardians provided sociodemographic information. Adolescents answered the Brazilian version of the Family Adaptability and Cohesion Scales (FACES III) to measure family functioning, and the Brazilian Rapid Estimate of Literacy in Dentistry (BREALD-30) to measure OHL. Descriptive analysis was conducted, followed by robust Poisson's regression analysis for complex samples with a multilevel approach (p<0.05). Rate ratio (RR) and 95% confidence intervals (CI) were calculated. The two levels of the analysis were students and schools. Adolescents enrolled at schools with higher grade-retention rate had slightly worse OHL scores (RR = 0.99; 95% CI: 0.98 to 0.99). The following individual factors were associated with the level of OHL: the female sex (RR = 1.05; 95% CI: 1.01 to 1.10), mother's schooling more than eight years (RR = 1.13; 95% CI: 1.08 to 1.19), younger guardians (RR = 0.94; 95% CI: 0.90 to 0.97) and a balanced family functioning (RR = 1.08; 95% CI: 1.01 to 1.14). Individual and contextual factors were associated with OHL in early adolescence.

Association between first oral examination characteristics and dental treatment needs in privately insured children: A claims data analysis

BACKGROUND

Early childhood caries (ECC) remains the most common, preventable infectious disease among children in the United States. Screening is recommended after the eruption of the first tooth, but it is unclear how the age at first dental examination is associated with eventual restorative treatment needs. The authors of this study sought to determine how provider type and age at first dental examination are associated longitudinally with caries experience among children in the United States.

METHODS

Deidentified claims data were included for 706,636 privately insured children aged 0 through 6 years as part of the nationwide IBM Watson Health Market Scan (2012-2017). The authors used Kaplan-Meier survival analysis to describe the association between the age of first visit and restorative treatment needs.

RESULTS

A total of 21% of this population required restorative treatment, and the average age at first dental examination was 3.6 years. A multivariable Cox proportional hazards model showed increased hazard for restorative treatment with age at first dental visit at 3 years (hazard ratio, 2.05; 95% CI, 1.97 to 2.13) and 4 years (hazard ratio, 3.99; 95% CI, 3.84 to 4.16).

CONCLUSION

The high proportion of children requiring restorative treatment and late age at first dental screening show needed investments in educating general dentists, medical students, and pediatricians about oral health guidelines for pediatric patients.

PRACTICAL IMPLICATIONS

Communicating the importance of children establishing a dental home by age 1 year to parents and health care professionals may help reduce disease burden in children younger than 6 years.

Which determinants should be considered to reduce social inequalities in paediatric dental care access? A cross-sectional study in France

Better access to dental care through systemic and educational strategies is needed to lessen the burden of disease due to severe early caries. Our study aims to describe family characteristics associated with severe early caries: parental knowledge, attitudes, practices in oral health and socio-demographic factors. For this cross-sectional study, 102 parents of children aged under 6 years with severe early caries and attending paediatric dentistry service in France completed a questionnaire during face-to-face interviews. Caries were diagnosed clinically by calibrated investigators, using the American Academy of Paediatric Dentistry criteria, and dental status was recorded using the decayed, missing, and filled teeth index. The majority of children were from underprivileged backgrounds and had poor oral health status, with a median dmft index of 10. Parents highlighted the difficulty of finding suitable dental care in private practices. Parents appeared to have good oral health knowledge and engaged in adapted behaviours but showed a low sense of self-efficacy. They perceived the severity of early caries as important but the susceptibility of their child as moderate. The study affirmed the importance of improving the accessibility of paediatric dental care and developing educational strategies to enhance the knowledge, skills, and oral health practices of families.

Influence of Parental Health Literacy on Change over Time in the Oral Health of American Indian Children

In cross-sectional studies, parental health literacy (HL) is associated with children’s oral health. It is unclear, however, whether HL influences pediatric outcomes. We examined the relationship of HL with change over time in parental oral health knowledge, beliefs, and behaviors, as well as pediatric oral health outcomes. We used longitudinal data from a study designed to reduce dental decay in American Indian children (N = 579). At baseline and annually for three years, parents answered questions assessing HL; oral health knowledge, beliefs, and behaviors; and pediatric oral health status. The number of decayed, missing, and filled tooth surfaces (dmfs) was computed based on annual dental evaluations. Linear mixed models showed that HL was significantly associated with all constructs, except dmfs, at their reference time points and persistently across the three-year study period. HL predicted change over time in only one variable, parents’ belief that children’s oral health is determined by chance or luck. HL is strongly associated with oral health knowledge, beliefs, behaviors, and status prospectively but is not a key driver of change over time in these oral health constructs.

Association of Oral Health Literacy and School Factors with Untreated Dental Caries among 12-Year-Olds: A Multilevel Approach

Dental caries are a global health problem that affects all age groups and must be considered a public health priority due to its significant financial costs and impact on the quality of life. This study evaluated the association between oral health literacy (OHL), school factors, and untreated dental caries in 12-year-old Brazilian adolescents using a multilevel approach. A population-based cross-sectional study was carried out with 740 adolescents randomly selected from private and public schools in Campina Grande, Brazil. Two dentists were trained and calibrated to diagnose dental caries using the Nyvad index and OHL using the Brazilian Rapid Estimate of Literacy in Dentistry (BREALD-30). The caregivers of the adolescents reported demographic data (sex, skin color, and socioeconomic status). Data of school factors such as the type of school and the school grade retention rate were classified through a 2-step hierarchical cluster analysis to obtain the school environment. A robust multilevel log-linear negative binomial regression for complex samples was performed (p < 0.05). In the analysis, adjusted by individual determinants, nonwhite skin color (RR = 2.20; 95% CI 1.56-3.12), a low socioeconomic status (RR = 1.60; 95% CI 1.09-2.34), a low OHL score (RR = 0.94; 95% CI 0.91-0.98), and low satisfaction with the last dental appointment (RR = 2.25; 95% CI 1.67-3.04) were associated with untreated dental caries. The following factors remained associated with untreated dental caries in the final model: students from an unfavorable learning environment (RR = 2.20; 95% CI 1.27-3.80), nonwhite skin color (RR = 1.92; 95% CI 1.27-2.91), a low socioeconomic status (RR = 1.82; 95% CI 1.12-2.94), a low OHL score (RR = 0.95; 95% CI 0.91-0.98), and low satisfaction with the last dental appointment (RR = 2.07; 95% CI 1.47-2.91). Untreated dental caries in early adolescence were impacted by the school environment, the socioeconomic status, OHL, and the adolescent's satisfaction with the last dental appointment.

Trends and developments in oral health literacy: a scientometric research study (1991-2020)

Objective

This study aimed to establish the current situation, intellectual base, hotspots, development trends, and frontiers of oral health literacy (OHL) from the literature.

Methods

We analyzed 1505 bibliographic records dated between January 1990 and December 2020 retrieved from the Web of Science Core Collection and the Scopus database. We used CiteSpace for word frequency analysis, co-occurrence analysis, co-citation analysis, clustering analysis, and burst analysis.

Results

The total number of publications increased year-on-year, with the majority of publications coming from the USA. Most studies focused on the relationship between (oral) health literacy and oral health, and the development of OHL instruments. The top 10 keywords by frequency were “health literacy”, “oral health”, “attitude to health”, “dental caries”, “adult”, “children”, “dental care”, “knowledge”, “questionnaire”, and “adolescent”. The keyword with the highest burst intensity was “dental health education”.

Conclusions

OHL research is a thriving field. The field is focused on the development of an OHL instrument and health promotion practice. Strategic cooperation among countries, institutions, authors, hospitals, and communities will be important to encourage further OHL research and address oral health problems.

Rural schoolteachers' knowledge about oral health and perceived roles in oral health education

OBJECTIVES

To explore schoolteachers' knowledge about oral health, their perception of their role as oral health educators, and their preparedness to teach oral health in rural public schools.

METHODS

We conducted a survey of 119 schoolteachers in four public elementary and middle schools in rural Minnesota during spring semester of 2019. We used descriptive statistics to analyze the data.

RESULTS

Sixty percent of 119 teachers participated. Schoolteachers have knowledge about basic oral health hygiene but have limited awareness about fluoride and periodontal disease. Correct agreements to the fluoride statements ranged from 23 percent to 87 percent and 23 percent to 70 percent agreed correctly to statements about periodontal disease. They prefer passive roles in oral health education. There was a high rate of agreement (51-83 percent) to integrate oral health topics with subjects taught in classrooms.

CONCLUSIONS

Schoolteachers see themselves as integrating oral health topics in the subjects they currently teach but will need further training to augment their limited knowledge of oral health.

Assessment of Parents' Oral Health Literacy and Its Association with Caries Experience of Their Preschool Children

(1) Purpose: To assess the oral health literacy (OHL) of parents and its association with the caries experience of their preschool children attending the Hospital University Sains Malaysia (HUSM), Kota Bharu, Kelantan, Malaysia. (2) Materials and Methods: This is a descriptive cross-sectional study involving a systematic random sampling method, using a sample of 230 parent/preschool child dyads. Among 230 parents, 24 were males and 206 were females (mean age 31.43 ± 5.82); among 230 children, 92 were boys and 138 were girls (mean age 4.82 ± 1.04) attending the pedodontics clinic, HUSM, who participated and met the inclusion criteria. A structured, self-administered oral health literacy questionnaire including sociodemographic factors was used in this study. A child's oral examination was performed to check the dmft (decayed, missing, filled teeth) status. Statistical analysis was done using descriptive and Spearman's correlation analysis and multivariate regression analysis. (3) Results: The mean dmft score of children in relation to the OHL level of parents showed a significant difference (p < 0.00). The mean dmft score of children in relation to the OHL level of parents showed the following relationships: Inadequate (7.49 ± 4.10) followed by marginal (3.28 ± 2.67) and then adequate (0.55 ± 1.55). The incidence of caries amongst children in relation to parental employment was more associated with unemployed parents (6.11 ± 4.43) than with employed parents (2.79 ± 3.65). The caries experience amongst children in relation to education of their parents revealed a significant difference (p < 0.001), and the mean dmft score was high amongst preschool children with primary school qualified parents (10.7 ± 4.10) followed by high school (7.04 ± 3.68), vocational (5.81 ± 3.57), diploma (2.61 ± 2.81), and university (1.29 ± 2.27), respectively. The results revealed a valid significant difference (negative correlation, rs = -0.753 **) between the OHL of parents with the dmft score of their preschool children. The age and gender of parents was not significantly associated with OHL, whereas ethnicity (positive correlation, rs = 0.283 **), education (positive correlation, rs = 0.865 **), and employment (negative correlation, rs = -0.490 **) were found to be significant. Conclusion: We conclude that there is a significant association between the OHL of parents with the dmft score of their preschool children. The logistic regression showed that after adjustment for sociodemographic factors, parents' gender (OR = 0.067, 95% CI: 0.012-0.360), parents' employment status (OR = 3.247, 95% CI: 0.897-11.754), parents' OHL score (OR = 0.042, 95% CI: 0.016-0.114), and child age (OR = 2.195, 95% CI: 1.249-3.857) were significantly associated with dental caries in children. Our study concluded that parents' employment status, age, gender, OHL, and child's age were significantly associated with the caries experience of their preschool children.

[Social inequalities in oral health and early childhood caries: How can they be effectively prevented? A scoping review of disease predictors]

BACKGROUND

Early childhood caries represent a major public health problem. In addition to their individual impact, the massive social inequalities in oral health that are at the roots and result from the disease have largely underestimated consequences for the child, his family and the community. In response to the question of "how and where to act?", this scoping review identifies the individual characteristics associated with the disease on which it would be possible to act, using appropriate prevention strategies.

METHODS

This scoping review is aimed at describing and analyzing available data in the literature on the different factors associated with early childhood caries.

RESULTS

The predictors of early childhood caries are represented by mediating (knowledge, attitudes and parents' oral health practices) and moderating (psychosocial parameters, parental health literacy and alcohol consumption) factors. Twenty-eight articles fulfilled the selection criteria, twenty of which studied mediators related to early childhood caries, and fourteen of which dealt with moderators. The lower the parents' level of knowledge and literacy in oral health, the higher a child's dmft index. Additional studies are needed to assess the role of psychosocial parameters.

CONCLUSION

Parents' knowledge and oral health literacy are the key predictors to be preferentially targeted in view of reducing social inequalities in health through actions undertaken on a local scale. The prevention of early childhood caries necessitates a combination of generic and targeted interventions.

Potentials of School Nursing for Strengthening the Health Literacy of Children, Parents and Teachers

Health literacy (HL) plays a key role in explaining health disparities. School nurses (SN) provide health related expertise within the school setting. A positive effect on the HL of children but also their teachers and parents has been suggested by some research, but gaps persist in the available information. As a pilot project, SN, which are not common in German schools, were placed in 28 public elementary and secondary schools in two German states. Children (11+ years, n = 2773), parents (n = 3978) and teachers (n = 420) participated in a 2017 baseline (T0) survey. Data collection was repeated in 2018 (T1). HL was measured using the Health Literacy for School-Aged Children scale (HLSAC) (children) and the European Health Literacy Short Scale (HLS-EU-Q16) (adults). Descriptive and multivariate data analyses were carried out. The HL of all groups increased between T0 and T1. Low child HL decreased from 17.9% to 14.9%. Problematic and inadequate HL dropped from 43.8% to 38.8% among parents and from 49.9% to 45.8% among teachers. Improvements were significant for children and parents but not for the teachers. Despite the relatively short intervention period and a relatively non-specific spectrum of interventions, there is some evidence that SN may contribute to strengthening HL within the school setting. The longer-term effects of SN on health literacy and child health should be further examined. For this, a clearer conceptualization of the scope of work of the SN in Germany including their educational interventions is imperative.

Developing Children's Oral Health Assessment Toolkits Using Machine Learning Algorithm

OBJECTIVES

Evaluating children's oral health status and treatment needs is challenging. We aim to build oral health assessment toolkits to predict Children's Oral Health Status Index (COHSI) score and referral for treatment needs (RFTN) of oral health. Parent and Child toolkits consist of short-form survey items (12 for children and 8 for parents) with and without children's demographic information (7 questions) to predict the child's oral health status and need for treatment.

METHODS

Data were collected from 12 dental practices in Los Angeles County from 2015 to 2016. We predicted COHSI score and RFTN using random Bootstrap samples with manually introduced Gaussian noise together with machine learning algorithms, such as Extreme Gradient Boosting and Naive Bayesian algorithms (using R). The toolkits predicted the probability of treatment needs and the COHSI score with percentile (ranking). The performance of the toolkits was evaluated internally and externally by residual mean square error (RMSE), correlation, sensitivity and specificity.

RESULTS

The toolkits were developed based on survey responses from 545 families with children aged 2 to 17 y. The sensitivity and specificity for predicting RFTN were 93% and 49% respectively with the external data. The correlation(s) between predicted and clinically determined COHSI was 0.88 (and 0.91 for its percentile). The RMSEs of the COHSI toolkit were 4.2 for COHSI (and 1.3 for its percentile).

CONCLUSIONS

Survey responses from children and their parents/guardians are predictive for clinical outcomes. The toolkits can be used by oral health programs at baseline among school populations. The toolkits can also be used to quantify differences between pre- and post-dental care program implementation. The toolkits' predicted oral health scores can be used to stratify samples in oral health research.

KNOWLEDGE TRANSFER STATEMENT

This study creates the oral health toolkits that combine self- and proxy- reported short forms with children's demographic characteristics to predict children's oral health and treatment needs using Machine Learning algorithms. The toolkits can be used by oral health programs at baseline among school populations to quantify differences between pre and post dental care program implementation. The toolkits can also be used to stratify samples according to the treatment needs and oral health status.