Is dental health education effective? A systematic review of current evidence

Effectiveness of School-Based Oral Health Education for Children and Adolescents in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

The global burden of oral diseases is high, but access to oral health care is still problematic, especially in low- and middle-income countries. The prevention of oral diseases in the child and adolescent population is the key as it can be prevented and potentially reversed at its early stages. This study aimed to provide evidence on the effectiveness of school-based oral health education in low- and middle-income countries through a systematic review and meta-analysis. Eligible studies had outcomes, such as oral health knowledge, behavior, oral hygiene, gingival health, and caries index, and those published from 1995 to 2019 in English. After screening and reviewing the retrieved articles, 20 studies were included in the systematic review and six eligible studies were selected for meta-analysis. The computed effect size of school-based oral health education in low- and middle-income countries showed improved knowledge, behavior, oral hygiene, and gingival health from the selected studies. However, most of the interventions took place for less than one year, and long-term evidence is still lacking. As repetition and reinforcement are critical in maintaining long-term effects, both country context and sustainability should be considered in school-based oral health education.

The effect of mass media campaigns on oral health knowledge: A systematic review and meta-analysis

OBJECTIVES

Knowledge and awareness gained from mass media can prepare people for lifestyle changes and impact their health and well-being. Considering the differences in the results of primary studies, we decided to conduct this study to evaluate the effect of mass media campaigns on oral health knowledge as a systematic meta-analysis and review.

METHOD

The databases such as the Web of Sciences (ISI), Scopus, PubMed/Medline, and the Cochrane Library were searched systematically until February 2022. Data pooling was performed using a random effects model. The effect sizes were estimated as odds ratios (ORs) with their 95% confidence intervals (CIs). Additional analyses, including sensitivity, subgroup, and publication bias analyses, were also conducted.

RESULTS

Our meta-analysis comprised a total number of seven articles. The pooled results indicated significant increases in oral health knowledge among included studies (OR = 1.64, 95% CI: 1.20-2.24, p < 0.001). In subgroup analyses, the effects of mass media campaigns on oral health knowledge remained significant for the studies with follow-up of less than 150 weeks (OR = 1.69, 95% CI: 1.49-1.91) and working-age populations (OR = 1.80, 95% CI: 1.40-2.32) compared to other categories.

CONCLUSION

In general, this study showed that mass media campaigns may have positive effects on oral health knowledge, especially in the working-age population; it seems that for improving health knowledge among children, more initiatives are needed. Besides, the effects of these campaigns seem to be time-dependent and higher in shorter follow-up periods.

Oral Health Promotion among Individuals with Intellectual Disabilities: A Systematic Review

People with disabilities experience inferior health and poor access to good quality health services as compared with the general population. Optimum oral health is associated with improvement in the quality of life in such patients. As oral diseases are largely preventable, good oral health education can have a positive impact on individuals with disabilities. So, the aim of the study was to review the effectiveness of oral health promotion among individuals with intellectual disabilities (IDs). Seven electronic databases were searched using keywords like intellectual disability/mental retardation/learning disability AND dental health education/health promotion. All records that were identified electronically from this search were subjected to a preliminary review to identify eligible papers. Identified studies were grouped into oral health promotion directed at individuals with IDs, and those aimed at caregivers of people with IDs. Interpretation of the outcomes included the effects on oral health knowledge, attitudes, and behaviors (either observed or self-reported). Eventually, 16 studies were included in the review including five studies that were randomized controlled trials, while the remaining 11 studies were pre-post single group oral health promotion studies. Critical appraisal of each study was conducted with the 21-item criteria by Kay and Locker (1997) to provide a numerical quantification and ranking of the evidence. Positive changes in the behaviors and attitudes were observed, while other studies reported a considerable improvement in the knowledge of caregivers for oral healthcare of individuals with IDs. However, such activities need to be done over a long period of time with constant monitoring.

Effectiveness of e-learning to promote oral health education: A systematic review and meta-analysis

BACKGROUND

In recent times during and after the COVID-19 pandemic, e-learning is increasingly being used to give oral health education. However, the efficacy of e-learning in improving and promoting the oral hygiene and oral health knowledge, attitude and practice is unclear. Therefore, this systematic review and meta-analysis aim to clarify the effectiveness of e-learning compared to other conventional education methods for providing oral health.

METHODS

An electronic database search was performed on PubMed-Medline, Scopus, and CENTRAL (Central Register Cochrane of Controlled trials). Randomized controlled trials (RCTs), including cluster or group RCTs, were collected in this study. The risk of bias was assessed with the Cochrane Handbook for Systematic Reviews of Interventions. Five different meta-analyses were conducted for plaque index, gingival index, oral health knowledge, oral health attitude, and oral health practice using a random effects model.

RESULTS

A total of 282 articles were found through the database search; 19 articles were included in the qualitative synthesis and 9 articles in the quantitative synthesis. The meta-analysis found that compared with conventional education, e-learning exhibited no positive effect. However, the use of e-learning was superior to conventional education methods for oral health practice for adults in subgroup analysis.

CONCLUSIONS

This paper could not indicate the effectiveness of e-learning in comparison with conventional education for oral health in total. However, for adults, it may be effective to get the oral health practice compared to the conventional education. Our study limitation is that there are only few studies that have assessed the effectiveness of e-learning. Therefore, numerous further high-quality studies should be conducted regarding the efficacy of e-learning compared with conventional education methods for oral health promotion.

Motivational Interviewing and Childhood Caries: A Randomised Controlled Trial

BACKGROUND

This study tested the occurrence of early childhood caries (ECC) and changes in potential mediators of ECC after an early childhood oral health promotion intervention.

METHODS

Consenting parent/child dyads in Western Australia were randomised into test [motivational interviewing (MI) + anticipatory guidance (AG)] or control (lift the lip assessments by child health nurses). A questionnaire at baseline and follow-ups (at 18, 36 and 60 months) evaluated the parental factors and the children clinically examined. Data were analysed using parametric and non-parametric tests for two groups and paired comparisons. Multivariable analysis used negative binomial regression with robust standard errors for over-dispersed count data and effect estimates presented as incidence rate ratios.

RESULTS

Nine hundred and seventeen parent/child dyads were randomised (test n = 456; control n = 461). The parental attitude toward a child's oral hygiene needs improved among the test group at the first follow-up (n = 377; baseline 1.8, SD 2.2, follow-up 1.5, SD 1.9, p = 0.005). Living in a non-fluoridated area and parents holding a fatalistic belief increased the risk of caries (IRR = 4.2, 95% CI 1.8-10.2 and IRR = 3.5, 95% CI 1.7-7.3), respectively, but MI/AG did not reduce the incidence of dental caries.

CONCLUSION

The brief MI/AG oral health promotion intervention improved parental attitude but did not reduce ECC.

Evolution and development of methodologies in social and behavioural science research in relation to oral health

The aim of this introductory paper is to provide an overview of key methodological developments in social and behavioural research in oral health. In the first section, we provide a brief historical perspective on research in the field. In the second section, we outline key methodological issues and introduce the seven papers in the theme. Conceptual models can contextualize research findings and address the 'why' and 'how' instead of 'what' and 'how many'. Many models exist, albeit they need to be evaluated (and adapted) for use in oral health research and in specific settings. The increasing availability of big data can facilitate this with data linkage. Through data linkage, it is possible to explore and understand in a broader capacity the array of factors that influence oral health outcomes and how oral health can influences other factors. With advances in statistical approaches, it is feasible to consider casual inferences and to quantify these effects. There is a need for not only individual efforts to embrace causal inference research but also systematic and structural changes in the field to yield substantial results. The value of qualitative research in co-producing knowledge with and from human participants in addressing 'the how' and 'the why' factors is also key. There have been calls to employ more sophisticated qualitative methods together with mixed methods approaches as ways of helping to address the complex or Wicked Problems in population oral health. In the final section, we outline possible future methodological directions in social and behavioural oral health research including participatory approaches and the development of core outcome sets. Our overriding goal in the paper is to facilitate a critical debate in relation to methodological issues which can be used to improve understanding and generate knowledge in population oral health and that this, in turn, will help inform oral health policy and practices.

Inequities and oral health: A behavioural sciences perspective

OBJECTIVES

The importance of tackling ongoing dental health inequities, observed both within and across countries, cannot be overstated. Alarmingly, health inequities in some areas are widening, resulting in an urgent need to act. The objective of this commentary is to explore oral health inequities through the lens of behavioral science and discuss adapting evidence based interventions for populations experiencing health inequities.

METHOD/RESULTS

The first section of this paper aims to describe the role of health disparities and inequities within oral health, with a specific focus on behaviours. The determinants, from upstream to downstream, and the interplay between these levels of intervention are discussed. This is followed by an overview of oral health promotion interventions, again with a focus on behaviours, which could potentially improve oral health while also taking into account oral health inequities. It is essential to translate evidence-based interventions (EBIs) to populations that have the greatest burden of disease. The second section of this paper discusses the rationale for cultural adaption of EBIs, criteria to justify EBIs and considers different cultural adaptation strategies necessary for the development and testing of effective, engaging, equitable and culturally relevant interventions.

CONCLUSIONS

We conclude with future directions for the development of theory-based multi-level interventions, guided by extent evidence-based interventions, and transdisciplinary approaches to science and key stakeholders such as patients, providers and payers.

The Impact of Dental Care Programs on Individuals and Their Families: A Scoping Review

BACKGROUND

Despite significant global improvements in oral health, inequities persist. Targeted dental care programs are perceived as a viable approach to both improving oral health and to address inequities. However, the impacts of dental care programs on individual and family oral health outcomes remain unclear.

OBJECTIVES

The purpose of this scoping review is to map the evidence on impacts of existing dental programs, specifically on individual and family level outcomes.

METHODS

We systematically searched four scientific databases, MEDLINE, EMBASE, CINAHL, and Sociological Abstracts for studies published in the English language between December 1999 and November 2021. Search terms were kept broad to capture a range of programs. Four reviewers (AG, VD, AE, and KKP) independently screened the abstracts and reviewed full-text articles and extracted the data. Cohen's kappa inter-rater reliability score was 0.875, indicating excellent agreement between the reviewers. Data were summarized according to the PRISMA statement.

RESULTS

The search yielded 65,887 studies, of which 76 were included in the data synthesis. All but one study assessed various individual-level outcomes (n = 75) and only five investigated family outcomes. The most common program interventions are diagnostic and preventive (n = 35, 46%) care, targeted children (n = 42, 55%), and delivered in school-based settings (n = 28, 37%). The majority of studies (n = 43, 57%) reported a significant improvement in one or more of their reported outcomes; the most assessed outcome was change in dental decay (n = 35).

CONCLUSIONS

Dental care programs demonstrated effectiveness in addressing individual oral health outcomes. However, evidence to show the impact on family-related outcomes remains limited and requires attention in future research.

'It's their mouth at the end of the day': dental professionals' reactions to oral health education outcomes

Introduction Research has established varying levels of efficacy of oral health education (OHE) efforts. However, little is known regarding how outcomes impact dental professionals and their OHE practice. This study explores dental professionals' reactions to varying OHE outcomes and their motivations to persist with their efforts.Methods Qualitative, semi-structured interviews were conducted with dental team members working in mainly NHS general dental practices in South Wales, UK. Interviews were conducted face-to-face pre-COVID-19 and then by telephone, transcribed and analysed thematically.Results In total, 30 interviews were conducted (17 dentists, 6 dental therapists and 7 dental nurses). Pleasure was gained from improved patient oral health. Responses to non-adherence included disappointment, frustration and acceptance. Acceptance centred around a shared responsibility for oral care between clinician and patient and reassurance that they had 'done their job'. The unpredictability of patient adherence aided OHE motivation; efforts might eventually inspire patient action or might align with patient readiness to change.Conclusions This study reveals how OHE outcomes impact on dental professionals' perceptions of their role and personal motivations for continued educational efforts with patients. Greater emphasis on both preventative dentistry and self-care, coupled with understanding of the complex factors influencing oral health behaviour, would aid motivation for OHE.

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

Background

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

Methods

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

Results

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

Conclusions

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

Upstream interventions to promote oral health and reduce socioeconomic oral health inequalities: a scoping review protocol

INTRODUCTION

Improving oral health and reducing oral health inequalities is an important global health priority. 'Upstream interventions' are a vital part of the collective effort to reduce oral disease burdens, however it is a rather nebulous term. Furthermore, there is little evidence on the effectiveness, impact and sustainability of upstream interventions that have focused on oral health and wider public health measures that impact on oral health. The aim of this scoping review is to systematically map and synthesise evidence on the effectiveness, impact and sustainability of upstream interventions on population oral health and reducing socioeconomic oral health inequalities.

METHODS AND ANALYSIS

This scoping review will be conducted in accordance with the Joanna Briggs Institute methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist. A detailed search strategy will be used to conduct a comprehensive search of electronic databases: Scopus, Embase and MEDLINE, PsycINFO and CINAHL, ASSIA and Cochrane Database of Systematic Reviews. A search of grey literature will also be completed to identify relevant dissertations, governmental reports and evaluations of implemented policies. Identification and extraction of data will be performed by two pairs of reviewers. Oversight and feedback will be provided by an independent expert advisory group.

ETHICS AND DISSEMINATION

This study will review published and available grey literature and does not require an ethics review. The scoping review protocol has been registered with the Open Science Framework. The final report will be circulated and disseminated through publication and feed into the work of the ongoing Lancet Commission on Oral Health. Due to the policy relevance of this work, discussions will take place with key stakeholders regarding the implications of the findings for future policy development.

Caries Experience and Its Relationship with Mother\'s Educational Level and Occupational Status: A Cross-sectional Survey

Aim

Most studies have investigated established risk factors contributing to dental caries in children, however, with the growing incidence of caries in children more risk factors are being included in literature. Thus, this cross-sectional study was conducted to assess the relationship between mother's educational level and occupational status with the caries experience of the child.

Materials and method

About 120 mother–child pairs participated in the study. Children below 12 years were screened for their dental caries status using DMFT index. The pairs were equally divided into three groups according to the mother's education and occupational status as: Group I–Mothers who did not receive any formal education, Group II–Educated mothers but unemployed, and Group III–Educated employed mothers. Mother's knowledge and attitude regarding the child's oral health was recorded analyzed using Chi-square test with statistical significance set at p < 0.05.

Results

In the present study, the lower DMFT score has been significantly related to higher levels of education and occupation of the mother. It was also observed that the knowledge and attitude of the mother related to the child's oral health is directly proportional to the education and occupational status.

Conclusion

The findings of our study suggest that mother's level of education increases the awareness of the child's oral health. Therefore, it is utmost important to educate a mother to help the child maintain his oral health and reduce the caries prevalence.

Clinical significance

The results of the present study conducted will help the clinician to keep in sight the relationship of mother's education and occupational level and its impact on their child's teeth, which will in turn help them for creating further dental awareness in the society.

How to cite this article

Nembhwani HV, Varkey I. Caries Experience and Its Relationship with Mother's Educational Level and Occupational Status: A Cross-sectional Survey. Int J Clin Pediatr Dent 2022;15(S-2):S226–S229.

The Efficacy of a Multi-Theory-Based Peer-Led Intervention on Oral Health Among Hong Kong Adolescents: A Cluster-Randomized Controlled Trial

PURPOSE

This study aimed to investigate the effects of a peer-led oral health intervention based on the Health Belief Model and the Social Cognitive Theory on improving oral health among Hong Kong adolescents.

METHODS

The study adopted a cluster-randomized controlled trial design, and 1184 students in 12 schools were randomized to intervention or control groups. After baseline assessment, the intervention group received a peer-led theory-based oral health intervention, while the control group received booklets for oral health promotion. Self-reported brushing and flossing, Health Belief Model/Social Cognitive Theory constructs, and oral health-related quality of life (OHRQoL) were measured at baseline, 6 months, and 12 months, and dental plaque accumulation and caries status were measured at baseline and 12 months. The trial was registered at https://www.clinicaltrials.gov (NCT03694496).

RESULTS

Brushing, flossing, and OHRQoL improved more in the experimental group than in the control group at the 6-month follow-up compared with baseline (p < .001). The mean gain score difference was .81 for brushing, .47 for flossing, and -2.51 for OHRQoL. At the 12-month follow-up, the mean gain score of brushing frequency, plaque index, caries status, and OHRQoL were .18, -.28, -.32, and -2.79, respectively, which all sustained the significant difference (p < .001).

CONCLUSIONS

Our findings suggested that the Health Belief Model combined with Social Cognitive Theory in a peer-led intervention is effective to increase self-reported brushing frequency and improve oral hygiene status and OHRQoL among adolescents.

Child-, Family-, and Community-Level Facilitators for Promoting Oral Health Practices among Indigenous Children

Despite the preventive nature of oral diseases and their significance for general wellbeing, poor oral health is highly prevalent and has unfavourable ramifications for children around the world. Indigenous children in Australia experience disproportionate rates of early childhood caries compared to their non-Indigenous counterparts. Therefore, this paper aims to collate parental experiences and generate an understanding of facilitators for Indigenous childhood oral health. This project aggregated stories from parents of Indigenous children across South Australia who were participants in an early childhood caries-prevention trial. This paper explores facilitators for establishing oral health and nutrition behaviours for Indigenous children under the age of three through reflexive thematic analysis. Fisher-Owens' conceptual model for influences on children's oral health is utilised as a framework for thematic findings. Child-level facilitators include oral hygiene routines and regular water consumption. Family-level facilitators include familial ties, importance of knowledge, and positive oral health beliefs. Community-level facilitators include generational teaching, helpful community resources, and holistic health care. Recommendations from findings include the following: exploration of Indigenous health workers and elder participation in oral health initiatives; inclusion of Indigenous community representatives in mainstream oral health discussions; and incorporation of child-level, family-level, and community-level facilitators to increase support for efficacious oral health programs.

Risk Indicators and Treatment Needs of Children 2-5 Years of Age Receiving Dental Treatment under General Anesthesia in Saskatchewan

BACKGROUND

When compared to national averages in Canada, Saskatchewan has one of the highest rates of dental treatment under general anesthesia (GA) and average costs per child. Thus, the purpose of this cross-sectional study is to explore the risk indicators and treatment needs of children receiving dental treatment under GA in Saskatchewan.

METHODS

In this cross-sectional study, we recruited caregivers of children between 24 and 71 months of age in Saskatoon, Canada. Caregivers completed a 40-item questionnaire, which was supplemented with clinical data and then subject to statistical analysis (independent t-tests and one-way ANOVA).

RESULTS

A total of 90 caregiver/child dyads were enrolled with the mean age for children being 49.5 ± 12.3 months. The mean age of a child's first dental visit was 34.7 ± 15.3 months with only 37.9% of children having a dental home. The mean deft index was 11.7 ± 3.4, with an average of 10.9 ± 3.5 teeth receiving treatment. Additionally, location of primary residence (p = 0.03), family income (p = 0.04), family size (p = 0.01), parental education (p = 0.03), dental home (p = 0.04), and body mass index (p = 0.04) had a statistically significant association with a higher mean deft.

CONCLUSIONS

Our cross-sectional study confirms that children who require dental treatment under GA have a high burden of disease. While individual risk indicators such as diet and oral hygiene play a role in the progression of early childhood caries (ECC), we also demonstrate that children who do not have access to early preventive visits or a dental home are at a higher risk. In addition to improving motivation for oral hygiene at home and nutritional education, improving access to oral health care should be addressed in strategies to reduce ECC.

Impact of Motivational Interviewing on Parental Risk-Related Behaviors and Knowledge of Early Childhood Caries: A Systematic Review

BACKGROUND

Behavior is important in dental disease etiology, so behavioral interventions are needed for prevention and treatment. Motivational interviewing (MI) has been proposed as a potentially useful behavioral intervention for prevention of early childhood caries.

METHODS

Studies have evaluated the effectiveness of MI on reduction of the risk-related behaviors for early childhood caries (ECC) compared to dental health education (DHE) The aim of this systematic review was to assess the scientific evidence on MI applied to change parental risk-related behaviors. The potentially eligible studies involved the assessment of caries-related behaviors in caregivers receiving MI. Electronic search of English published literature was performed in February 2020 in the Scopus, Cochrane, PubMed, and Embase databases. Assessment of risk of bias was done by the Cochrane risk of bias tool.

RESULTS

Of 329 articles retrieved initially, seven were eligible for inclusion in this review. Four studies evaluated the behavior of tooth brushing and four studies assessed the cariogenic feeding practice, while only one study investigated the behavior of checking teeth for pre-cavities. Moreover, two studies examined dental attendance for varnish fluoride use and oral health-related knowledge. It was not possible to perform a meta-analysis.

CONCLUSIONS

Generally, results support the application of MI to improve the "dental attendance behavior for fluoride use" and participants' knowledge. However, the results were inconclusive for other behaviors. We need further and better designed interventions to completely evaluate the impact of MI on specific ECC-related behaviors.

Watch and learn? A systematic review comparing oral health educational videos with written patient information aimed at parents/carers or children

Introduction Childhood caries remains a major UK health issue. The COVID-19 pandemic has necessitated rapid introduction of innovative practice to minimise footfall into dental clinics. Video-based oral health education could help promote oral health advice remotely and has been included in national guidance. This systematic review evaluates the impact of video education versus written patient leaflets on knowledge and oral health behaviours in parents/carers or children.Method PubMed and Medline were searched. In total, 47 articles were identified and relevance assessed by examining titles and abstracts. Seven full-text articles were assessed and reference lists manually screened for additional publications. Three studies met the inclusion criteria.Results Only one study assessed participant knowledge gain and found no statistical significance between scores at baseline and after video, leaflet or hygienist-led education. For oral health behaviour change, one study demonstrated no significant difference in plaque score improvements between video and leaflet groups. The other showed significant improvements in plaque and bleeding scores for both leaflet and video groups compared to the control.Conclusion This review identified too few studies with heterogeneity to make conclusions on the impact of written versusvideo oral health education. A standardised outcome measurement tool is needed to evaluate the impact of current educational videos on oral health behaviour and knowledge. There is potential for video to educate the masses as we navigate through this pandemic.

Impact of oral hygiene training to Anganwadi and Accredited Social Health Activist workers on oral health of young children in tribal regions of Rajasthan State, India

CONTEXT

Early childhood caries is one of the most widespread diseases affecting children in urban and rural India. Community health workers can bring about a quantum of change in improving the oral health in children.

AIMS

The aim of the study was to assess the impact of oral health training imparted to Anganwadi and accredited social health activist (ASHA) workers on improving the oral hygiene of 148 children aged 1-6 years.

SETTINGS AND DESIGN

The preintervention followed by oral health training and postintervention assessment were done at three Anganwadi and ASHA centers of Rajasthan.

METHODOLOGY

The preintervention data included Decayed, Missing, and Filled Teeth/decayed, extracted, and filled teeth, oral hygiene indices (Oral Hygiene Index-Simplified [OHI-S] and Oral Hygiene Index Simplified-Modified [OHIS-M]), plaque index, and caries activity using Oratest. The oral health training consisted of PowerPoint presentations, video presentations, live demonstrations on brushing technique, rinsing, plaque disclosure, and flossing technique. They were enlightened on deleterious oral habits, emergency protocol on trauma, etc. The postintervention data included outcome measures consisting of oral hygiene indices (OHI-S and OHIS-M), plaque index, and Oratest after 2 months to evaluate the impact of training.

STATISTICAL ANALYSIS USED

The data were analyzed using Chi-square test, Fisher's exact test, independent t-test, paired t-test, and one-way analysis of variance test.

RESULTS

There was a significant improvement in toothbrushing practices and rinsing (P < 0.05). There was a significant difference in debris index, calculus index, OHI-S/OHIS-M, plaque index, and Oratest after intervention (P < 0.05).

CONCLUSION

Empowering Anganwadi and ASHA workers can be a feasible approach in India, where oral health is not a priority in primary health care as yet.

What influences the provision and reception of oral health education? A narrative review of the literature

OBJECTIVES

Most common diseases of the mouth are preventable through behavioural changes, oral hygiene routines and regular professional care. Research suggests dental professionals may prioritize clinical experience, personal values and preferences over evidence when delivering such interventions. Research also suggests variable rates of patient behaviour change following oral health education (OHE) interactions. This review explores the literature to answer the question: what factors influence the provision and reception of OHE messages and the wider OHE process?

METHODS

A structured search of literature was carried out with databases covering a range of academic disciplines (healthcare sciences, social sciences, education). Key words/terms were searched to elicit papers published since 1998. Citation mining (relevant citations within papers) and citation tracking (papers citing relevant papers) were also used. Recurring themes within the papers were identified and coded using NVivo12 and presented in a conceptual model.

RESULTS

The studies analysed tended to employ small-scale surveys, larger-scale surveys (some with low response rates), or interview studies of varying sizes. There was also a limited number of review papers. However, several key messages were identified regarding dental professionals' and patients' views on OHE and the factors that influence its provision. Factors that were identified related to the wider social and policy context (macro), community-level factors (meso), the individual practitioner and patient (micro), factors that influenced the nature of OHE interaction and any resulting behaviour change, and how the outcomes of the process influence future OHE interactions for both parties.

CONCLUSIONS

The literature highlighted how factors influence the OHE process before, during and after the educational interaction. The resultant conceptual model acknowledges the influence of wider 'upstream' factors alongside interpersonal and individual influences which should be taken into consideration when developing OHE interventions.

'We had to take a hammer to get some roots out' - experiences, motivations and challenges among volunteer dentists: a qualitative study

Objectives To address a gap in the literature by examining the experiences, motivations and challenges among volunteer dentists engaged in short-term missions to low- and middle-income countries.Methods In-depth interviews among volunteer dentists (n = 20) who had provided voluntary dental care in low- or middle-income countries within the preceding five years. Interviews lasted on average 55 minutes and were recorded, transcribed and analysed using NVivo. Routine debriefings complemented analysis. COREQ principles guided this research.Results Motivations to volunteer included: exposure to new dental challenges (enhancing competence); discovering a new setting (tourism); and enhancing the lives of clients (humanitarianism). Volunteers enjoyed undertaking new tasks and developing new skills, but were burdened by a high patient load, challenging clinical conditions, peri- and post-operative complications, and a concern that their work was not addressing root causes of inadequate access to basic dental care. Respondents recommended that more information regarding the vision, equipment status, armamentarium and dental supplies be made available pre-departure, and that more dental schools include training on global oral health. Such measures could facilitate volunteers' abilities to provide care while also enhancing their personal and professional development. Creating an appropriate, sizable and competent capacity-building programme for local dentists was described as essential.

Oral Health Interventions in Patients with a Mental Health Disorder: A Scoping Review with Critical Appraisal of the Literature

Poor oral health affects quality of life and daily functioning in the general population and especially in patients with mental health disorders. Due to the high burden of oral health-related quality of life in patients with a mental health disorder, it is important for nurses to know how they can intervene in an early phase. The aim of this systematic scoping review was to identify and appraise oral health interventions in patients with a mental health disorder. A systematic scoping review with a critical appraisal of the literature was conducted using the Joanna Briggs Institute (JBI) methodology for scoping reviews and their checklists. MEDLINE, CINAHL, PsycINFO and reference lists were searched from their inception until December 2020. Results: Eleven quantitative studies were included in the review: four randomized controlled trials, six quasi-experimental studies and one cohort study. Studies focused on interventions for patients (n = 8) or focused on patients together with their professionals (n = 3). Four types of oral health interventions in mental health were found: (I) educational interventions; (II) physical interventions; (III) interventions combining behavioural and educational elements and (IV) interventions combining educational and physical elements. All studies (n = 11) had an evaluation period ≤12 months. Nine studies showed an effect on the short term (≤12 months) with regard to oral health knowledge, oral health behaviour, or physical oral health outcomes (e.g., plaque index). Two studies showed no effects on any outcome. Overall, the methodological insufficient to good. Conclusion: Four types of interventions with positive effects (≤12 months) on oral health knowledge, oral health behaviour, and physical oral health outcomes in different diagnostic patient groups were found. Due to the heterogeneity in both interventions, diagnostic groups and outcomes, one golden standard oral health intervention cannot be advised yet, although the methodological quality of studies seems sufficient. Developing an integrated oral health toolkit might be of great importance in mental health considering its potential effect on oral health-related quality of life.

Analysis of the effectiveness of school programs for the prevention of dental diseases: a literature review

Relevance. The high prevalence of dental diseases worldwide and their cumulative process from an early age entail effective strategies for healthy habits promotion. Schools are recommended to include oral health education programs in the curricula to develop a positive attitude to oral hygiene among students. The aim was to review the effectiveness of implementing programs in the school curricula to reduce the dental disease level among schoolchildren.Materials and methods. The research chose programs aimed at improving the dental health of schoolchildren. We considered educational measures on oral health protection, carried out by dentists, nurses or teachers within school programs and curative and preventive measures for schoolchildren aged 6-18 years. We searched the publications on the given topic published between 1999 and 2021 in the database e-LIBRARY.ru and  between 2016 and 2021 in the PubMed database. When selecting articles, the full-text study was compulsory to check the article conformance degree to the inclusion criteria.Results. According to the keyword search, we found 76 publications in the database e-LIBRARY.ru. After the exclusion of duplicates and articles nonconforming to the selection criteria, the review included seven publications. Four studies revealed caries reduction, and two studies demonstrated the improvement of oral hygiene. In the PubMed database, 419 publications were found according to the keyword query. The analysis of the effectiveness of school dental programs included 12 articles. Four studies detected oral hygiene improvement, seven studies – caries reduction, and six studies – dental knowledge and skill improvement.Conclusions. According to Russian and international studies, education without curative and preventive measures isn't effective in dental disease prevention in schoolchildren. Along with instructions and training in practical oral hygiene skills, schoolchildren should use fluoride toothpaste. Fluoride varnish application and fissure sealing are the most effective measures in risk groups.

Reorienting Oral Health Services to Prevention: Economic Perspectives

Despite the recognized need to change the emphasis of health services by shifting the balance from treatment to prevention, limited progress has been made in many settings. This is true in oral health, where evidence for preventive interventions that work has not been systematically exploited in oral health services. While reorienting health services is complex and context specific, economics can bring a helpful perspective in understanding and predicting the impact of changes in resource allocation, provider remuneration systems, and patient payments. There is an increasing literature on the economics of different prevention approaches. However, much of this literature focuses on the costs and potential savings of alternative approaches and fails to take into account benefits. Even where benefits are taken into account, these tend to be narrowly focused on clinical outcomes using cost-effectiveness analysis, which may be of little relevance to the policy maker, patient, and the public. Some commonly used economic approaches (such as quality-adjusted life years and incremental cost-effectiveness ratios) may also not be appropriate to oral health. Using alternative techniques, including wider measures of benefit and employing priority setting and resource allocation tools, may provide more comprehensive information on economic impact to decision makers and stakeholders. In addition, it is important to consider the effects of provider remuneration in reorienting services. While there is some evidence about traditional models of remuneration (fee for service and capitation), less is known about pay for performance and blended systems. This article outlines areas in which economics can offer an insight into reorientation of health systems toward prevention, highlighting areas for further research and consideration.

Comparative evaluation of webinar, powerpoint presentation and lecture as oral health educational interventions among school children: a randomized controlled trial

The study compared the effectiveness of three teaching methods on the oral health status of high school children. The study population of 791 school children selected from three different schools was randomly allocated to one of three intervention groups: (i) Webinar group (Online presentation)-260 subjects, (ii) Face to Face lecture using PowerPoint presentation (F2F PP group)-261 subjects and (iii) Control group (Only lecture)-270 subjects. Subjects from the Webinar group and F2F PP group received oral health education at an interval of 15 days starting from baseline. Subjects from the control group received oral health education only at baseline. Oral Hygiene Index (OHI) and Gingival Index (GI) were measured at baseline, at 1 month, 2 months' and 3 months' interval. OHI and GI showed a significant reduction (P = 0.001) in the Webinar group and F2F PP group; However, in the control group, OHI and GI reduced from baseline till second month and showed an increase at 3 months' interval. F2F PP group showed a maximum reduction in OHI and GI followed by the Webinar group. It can be concluded that F2F PowerPoint-based oral health education was most effective followed by the webinar method.

Stressed-Out Oral Immunity: A Gateway From Socioeconomic Adversity to Periodontal Disease

OBJECTIVE

It has been suggested that adverse socioeconomic conditions "get under the skin" by eliciting a stress response that can trigger periodontal inflammation. We aimed to a) estimate the extent to which socioeconomic position (SEP) is associated with periodontal disease (PD) and proinflammatory oral immunity, and b) determine the contribution of psychosocial stress and stress hormones to these relationships.

METHODS

In this cross-sectional study (n = 102), participants (20-59 years old) completed financial and perceived stress questionnaires and underwent full-mouth periodontal examinations. SEP was characterized by annual household income and educational attainment. Cortisol, a biological correlate of chronic stress, was assessed in hair samples. Oral immunity was characterized by assessing oral inflammatory load and proinflammatory oral neutrophil function. Blockwise Poisson and logistic regression models were applied.

RESULTS

Compared with lower SEP, individuals in the middle- and higher-income categories had a significantly lower probability of PD (incidence rate ratio [IRR] = 0.5 [confidence interval {CI} = 0.3-0.7] and IRR = 0.4 [95% CI = 0.2-0.7]) and oral inflammatory load (IRR = 0.6 [95% CI = 0.3-0.8] and IRR = 0.5 [95% CI = 0.3-0.7]) and were less likely to have a proinflammatory oral immune function (odds ratio [OR] = 0.1 [95% CI = 0.0-0.7] and OR = 0.1 [95% CI = 0.0-0.9]). PD and oral immune parameters were significantly associated with financial stress and cortisol. Adjusting for financial stress and cortisol partially attenuated the socioeconomic differences in PD to IRR = 0.7 (95% CI = 0.5-0.8) and IRR = 0.6 (95% CI = 0.5-0.7) for the middle- and higher-income categories, respectively. Similar results were observed for proinflammatory immunity (OR = 0.2 [95% CI = 0.0-1.8] and OR = 0.3 [95% CI = 0.0-2.3]).

CONCLUSION

These findings suggest that psychosocial stress may contribute to a proinflammatory immunity that is implicated in PD pathobiology and provide insight into social-to-biological processes in oral health.

Maternal knowledge on early childhood caries and barriers to seek dental treatment in Jordan

Purpose

To assess maternal knowledge, attitudes and beliefs of Early Childhood Caries (ECC) risk factors and to determine barriers in seeking dental treatment among children with ECC.

Methods

A total of 600 mothers of healthy children, aged 3–5 years, with ECC attending maternity and child health centres in Jordan completed a questionnaire using face-to-face interviews. ECC was diagnosed clinically by the chief investigator, based on the diagnostic criteria suggested by American Academy of Paediatric Dentistry (AAPD), and caries was recorded using dmft index.

Results

The majority of the children had poor oral health status (99.2%) with a dmft index of 6.04 (± 1.2). Less than third (25.7%) of the mothers believed that their child had poor oral health with more than half (53.3%) not being aware that their child had dental caries. Most of the mothers had poor knowledge, attitudes and beliefs regarding their children’s oral health (82%). Participants` oral health knowledge was significantly associated with mothers` level of education and profession (p < 0.05). In addition, there was delay in seeking dental treatment for their children by the majority (65.9%) of mothers. Maternal profession, family income and time needed to reach a nearby health centre were found to be significant barriers in seeking dental treatment (p < 0.05).

Conclusion

The majority of the mothers of children in Jordan with ECC had poor knowledge about their children’s oral health status. Moreover, seeking dental treatment was delayed by a large number of mothers of children with ECC.

A public health approach for prevention of periodontal disease

Upwards of 1 in 10 adults worldwide may be affected by severe periodontitis, making the disease more prevalent than cardiovascular disease. Despite its global scope, its impact on pain, oral function, and the wellbeing of individuals, and the disproportionate burden of disease and the socioeconomic impact on communities, the perception that periodontal disease is a public health problem remains low. Although there have been substantial improvements in our understanding of the etiology of periodontal disease and how we can prevent and control it, these advances have been primarily focused on individual, patient-focused approaches. The prevention of periodontal disease depends on improving currently available individual interventions and on determining what public health interventions can be effective and sustainable under real-life conditions. Currently, public health approaches for periodontal disease prevention and control are lacking. This review traces the historical strategies for prevention of periodontal disease in an epidemiologic transition context, using a modified model developed for cardiovascular disease, and presents a possible public health approach. Improving periodontal disease prevention and control will need to take into consideration the core activities of a public health approach: assessment, policy development, and assurance.

Impact of motivational interviewing on early childhood caries: A systematic review and meta-analysis

BACKGROUND

The authors aimed to assess the scientific evidence on motivational interviewing for the clinical reduction of early childhood caries compared with traditional dental health education.

METHODS

Search terms were selected on the basis of Medical Subject Headings and non-Medical Subject Headings terms. The main key words were motivational interviewing, early childhood caries, and education. Potentially eligible studies involved the clinical assessment of caries rate in children whose parents or caregivers received motivational interviewing as an intervention. The authors assessed the risk of bias using the Cochrane risk-of-bias tool. In March 2019, the authors performed an electronic database search of literature published in English within the following databases: Scopus, Cochrane, PubMed, and Embase.

RESULTS

Of 329 articles retrieved initially, 14 were eligible for inclusion in the systematic review and 3 articles contributed to the meta-analysis. For statistical analysis, the mean difference of continuous data was analyzed at a 95% confidence interval using the random-effects model.

CONCLUSIONS

Overall, the evidence presented in this review was limited. Although the results of the meta-analysis showed that motivational interviewing is as effective as dental health education in controlling early childhood caries, we need more and better designed and reported interventions to assess its impact on early childhood caries accurately.

Knowledge and attitude of male schoolteachers towards primary dental care

Introduction:

Children are the most important natural resources. School is a location which helps to promote the health of staff, families, and community members along with the students. Teachers are the most resourceful manpower available to deliver any healthcare at school setup.

Aims and Objectives:

To assess the knowledge and attitude towards primary dental care among male schoolteachers at Al-Kharj Saudi Arabia.

Methodology:

A descriptive cross-sectional questionnaire survey was carried out involving male teachers working in primary schools at Al-Kharj KSA. A total of 350 teachers were included in this study. The data were collected using a self-administered questionnaire survey consisting of 17 questions related to knowledge and attitude towards dental care and oral hygiene practices.

Results:

The overall knowledge was fair among the schoolteachers (65.4%). Al-Kharj male schoolteachers were having a positive attitude. Teaching experience and knowledge showed a statistically significant relation (P < 0.05.

Conclusion:

Although primary schoolteachers had a fair knowledge and good attitudes towards dental care, there is a need to conduct training programs about oral health education in schools and check how teachers educate their children to maintain dental care.

Foldscope as a primary diagnostic tool for oral and urinary tract infections and its effectiveness in oral health education

Due to its speed, accuracy and cost-effectiveness, microscopy has become an integral part of clinical examination for disease diagnosis. However, modern microscopes are very costly and require skilled personnel for their operation and maintenance, and specimen processing and analysis is labour-intensive. Further, lack of such expensive diagnostic tools in remote areas is a serious concern. Affordable point-of-care diagnostic tools are the most useful for timely disease diagnosis and management. The Foldscope is an affordable origami-based microscopy device composed of a series of paper clippings, which, upon assembly, can hold a specimen slide for observation, and this specimen can be viewed via a mobile phone camera attached to it. The present study evaluated the use of the Foldscope in the clinical diagnosis of oral and urinary tract infections and evaluated its efficacy as a motivational tool for improving oral health among school children in India. We qualitatively compared the Foldscope to a clinical microscope by examining five different types of clinical samples. Of the different types of clinical samples, the Foldscope was effective in detecting infection in dental plaque samples and urine samples. Thus, we further analysed 31 dental plaque samples of patients aged 3-13 years and 25 urine samples of patients aged 11-62 years. We also evaluated the use of the Foldscope as an educational tool for motivating oral hygiene among 80 school children aged 12 years and found that students in the Foldscope intervention group had better measures of oral hygiene than did students in the nonintervention group. In summary, our study indicated that the Foldscope is useful in detecting urinary tract infections and kidney stones in urine samples and is a useful motivational tool for oral health education among school-aged children. Furthermore, it may also be useful in oral health monitoring in resource poor settings. LAY DESCRIPTION: Poor and remote population often suffers due to lack of capacity to buy products or avail services which are expensive. In such a society people are not able to afford even the basic detection of diseases. Foldscope may come to rescue here! Foldscope is a paper-based, use-and-throw, affordable microscope. This study explores the use of Foldscope in clinics and diseases diagnosis using patient samples. Preliminary detection of disease associated symptoms in dental and urinary infections and digital record keeping via storage in mobile phone memory and hospital OPD records for monitoring patient's health are some of the advantages of Foldscope for clinical use in resource poor settings. It identifies that Foldscope not only can be used by students or teachers for educational purposes but it can also pave a path for promotion of dental hygiene among young children. The study also suggests that further improvement in design or resolution of Foldscope will broaden the scope of its application, in future.

Motivational interviewing to prevent early childhood caries: A randomized controlled trial

OBJECTIVES

Prevailing health education (PE) often fails to achieve sustained behavioral changes. This randomized controlled trial integrated motivational interviewing (MI) and a patient communication tool featuring interactive caries risk assessment (RA) into PE and investigated the effectiveness of PE, PE + MI, and PE + MI + RA in preventing early childhood caries.

METHODS

This study targeted children aged 3-4 years with unfavorable oral health behaviors. 692 parent-child dyads were recruited, randomly assigned into three groups (PE, PE + MI, and PE + MI + RA), and received respective interventions. A questionnaire was completed at baseline and after 6 and 12 months to collect information on socio-demographic background, parental efficacy and children's oral health behaviors. Children's oral hygiene status and dental caries were recorded at baseline and after 12 months.

RESULTS

655 (94.7%) parent-child dyads remained in the study after 12 months. Caries increment was significantly lower in PE + MI group (β=-0.717, 95% CI: -1.035, -0.398) and PE + MI + RA group [β=-0.600, 95% CI: -0.793, -0.407] than in PE group. There was significantly greater reduction in plaque score in PE + MI group (β=-0.077, 95% CI: -0.106, -0.048) and PE + MI + RA group (β=-0.075, 95% CI: -0.113, -0.036), as compared with PE group. Significantly greater improvements were found in parental efficacy and children's oral health behaviors in PE + MI and PE + MI + RA groups than in PE group (all p < 0.05). There was no significant difference between PE + MI group and PE + MI + RA group across all outcome measures (all p > 0.05).

CONCLUSIONS

Intergration of motivational interviewing improves the effectiveness of prevailing health education in preventing early childhood caries, enhancing parental efficacy, and improving children's oral health behaviors. Incorporation of the communication tool for caries risk assessment does not further improve the effectiveness of motivational interviewing in protecting children's oral health.

CLINICAL SIGNIFICANCE

The findings of this study provide much needed evidence for dentists, dental auxiliary staff and public health workers to select effective intervention to empower parents for improving children's oral health behaviors and preventing early childhood caries.

[Not Available]

Objectif:

La santé bucco-dentaire des patients en psychiatrie est problématique, puisque le recours au chirurgien-dentiste demeure inférieur de 25 % à la population générale. En partant de ce postulat, nous avons souhaité comprendre en quoi l’anxiété et la douleur du patient peuvent impacter la prise en charge bucco-dentaire et le bon déroulement des soins.

Méthode:

Cette étude a été menée sur 100 patients hospitalisés en psychiatrie. Grâce à différentes échelles, nous avons évalué leur niveau d’anxiété et de douleur, mais aussi leur coopération aux soins.

Résultats:

L’anxiété ne constitue pas un frein à la prise en charge, et diminue significativement après les soins. Le comportement durant les soins bucco-dentaires des patients hospitalisés en psychiatrie semble similaire à celui de la population générale.

Conclusion:

Notre étude permet de mieux appréhender les soins dentaires en psychiatrie et devrait contribuer à placer les soins dentaires au centre de la prise en charge somatique en psychiatrie.

The effectiveness of behavioral interventions to improve oral health in adolescents at different periods of follow-up: A systematic review and meta-analysis

BACKGROUND

The aim of this review was to examine the effectiveness of behavioral interventions at different follow-up periods to improve adolescents' oral health.

METHODS

CENTRAL, MEDLINE, EMBASE and other databases were systematically searched. Inclusion criteria were as follows: participants aged 10-19 years old, randomized controlled trials using behavioral interventions, outcome measurements including oral health knowledge, attitudes, practices, and oral health status. For each included study, behavior change techniques (BCT) were identified and the quality and risk of bias assessments obtained. PROSPERO reference: CRD42018090341.

RESULTS

After searching and screening, 17 clinical trials were included in the systematic review. The most commonly used BCTs were behavior health link, information on consequences, and social comparisons. A significant reduction of plaque index was detected (SMD:-0.46; 95 % CI:-0.82∼-0.10) for 3 months and (SMD:-0.71; 95 % CI:-1.08∼-0.33) for 6 months. The reduction of gingival index after 6 months was also significant (SMD:-0.90; 95 % CI:-1.33∼-0.47). Oral health knowledge and oral health-related behavior were also improved after behavioral interventions.

CONCLUSION

There is moderate evidence that behavioral interventions are effective in promoting oral health in adolescents. To establish more evidence-based conclusions, further research should focus on: quality control of interventions, full descriptions regarding the BCT, long-term follow-ups, and behavior change reinforcements.

PRACTICAL VALUE

Given the need of early prevention of oral diseases, well-designed oral health promotion programme are needed to improve behavior and outcome of adolescents' oral health.

The Psychological Models of Health-related Behavior in Understanding Sugars Intake in Adults: A Review

Free sugars intake plays a major role in dental caries formation and other general health issues such as obesity. Therefore, interventions, which assist individuals or populations in the control of their free sugars intake, are of central importance in caries prevention strategies. There is good evidence that behavioral interventions benefit from a foundation in conceptual theories of behavior change founded on empirical data. In this review, we discuss the future application of seven theories, including six common psychological theories in predicting and developing interventions to reduce free sugars intake related to dental caries among adults. For each model, we summarize its key features and the data derived from its application in general and oral health settings and make recommendations for future research. We searched Medline, PsycINFO, Global Health, PubMed, and Embase databases to identify items dealing with dental caries, adults, sugars intake, and six psychological theories. These included the Transtheoretical Model of Change, Theory of Planned Behavior, Social Cognitive Theory, Information-Motivation-Behavioral Skills model, PRIME Theory, and Behavior Change Wheel theories. We searched literature published in the last 10 years, and priority was given to systematic reviews and randomized control trials. Although there is extensive literature on the application of the six psychological theories, there is a gap in knowledge about their effectiveness in reducing free sugars intake related to dental caries among adults. There is a need for better-designed trials of interventions based on the clear operationalization of psychological constructs to reduce sugars intake among the adult population.

A 21-Day School-Based Toothbrushing Intervention in Children Aged 6 to 9 Years in Indonesia and Nigeria: Protocol for a Two-Arm Superiority Randomized Controlled Trial

BACKGROUND

The World Health Organization reports that dental cavities affect 60% to 90% of children globally. FDI World Dental Federation and Unilever Oral Care have developed public health programs to improve brushing habits over their 12-year partnership. The last of these (phase III) named Brush Day & Night aimed to educate children on brushing twice daily with a fluoride toothpaste and gave useful information for a new project, phase IV. The 21-day Brush Day & Night program is an intense education activity designed to establish the habit of brushing day and night with a fluoride toothpaste. The program involves daily brushing instruction and includes free toothpaste and toothbrushes.

OBJECTIVE

The main objective of the study is to evaluate the impact of a 21-day school program on children's oral health. As a secondary objective, we aim to evaluate the impact on the knowledge, behavior, toothbrushing habits, and quality of life in school children aged 6 to 9 years after a 21-day school program and compare with baseline and a control group as measured by the self-reported questionnaires issued to children (in particular, the self-reported brushing frequency and positive responses on fluoridated toothpaste use). The enduring nature of the program will be determined by the inclusion of 8- and 24-week time points.

METHODS

The study is a 2-arm superiority randomized controlled trial. Clusters in this study are infant and junior schools in Indonesia and Nigeria. The study aims to recruit 20 schools with children aged 6 to 9 years in each country. At baseline, children in both intervention and control schools will answer a questionnaire and have their clinical oral health assessed using the Simplified Oral Hygiene Index (OHI) and Decayed Missing and Filled Teeth index. Children in the intervention schools will then take part in a structured 21-day Brush Day & Night intervention. Children in the control schools will be provided with free toothpaste and toothbrushes but will not receive the 21-day intervention. The questionnaires and OHI assessments are repeated after the 21-day program is completed and again 8 weeks later and 24 weeks later for all participating children. Parents/carers/guardians of all children will sign the informed consent and complete questionnaires on their own experience and attitudes toward oral health and toothbrushing routine at each of the four times points (baseline, 21 days, 8 weeks, and 24 weeks). The study will be conducted by the national dental associations of Indonesia and Nigeria and was approved by the ethics committees of both countries.

RESULTS

The study is ongoing. Recruitment of schools started in Indonesia in February 2018 and in Nigeria in April 2018 for the first part of the study, which concluded in Indonesia in September 2018 and in Nigeria in November 2018. The second part of the study (the second half of the schools) started in November 2018 in Indonesia and December 2018 in Nigeria.

CONCLUSIONS

We expect to collect all the data during 2019 and publish findings from the study by March 2020.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04001296; https://tinyurl.com/selxraa.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/14156.

A randomised controlled trial of a smartphone application for improving oral hygiene

Aim The study aimed to test the effectiveness and acceptability of a smartphone application used in conjunction with a movement sensor toothbrushing attachment for promoting plaque control. Method One hundred and eight dental practice patients were recruited to the study from two general dental practices. Participants were randomised to test and control groups, and both groups offered oral hygiene instruction according to a single protocol. Test participants were given the smartphone device and toothbrush attachment. Control patients were not. After two and four weeks, full mouth plaque scores of the mouths of both test and control participants were measured. A comprehensive questionnaire administered to the test group assessed participants' views about the acceptability of the smartphone device and application. Results Full mouth plaque scores declined from 40.1 to 11.7, a reduction of 70% in the test group compared to a reduction from 29.1 to 20.5 (30%) in the control group. The device was found to be very well accepted. Participants were conscious of improving their brushing and improving their knowledge of how to brush well. They also reported enjoyment and fun being derived from use of the device and found it simple to use. Conclusion Providing immediate day-to-day feedback to dental patients about their brushing results in dramatic improvements in oral hygiene and highly significant reductions in plaque levels, in at least the short-term; beyond that seen in previous toothbrushing interventions with adult patients.

Biologically Defined or Biologically Informed Traits Are More Heritable Than Clinically Defined Ones: The Case of Oral and Dental Phenotypes

The genetic basis of oral health has long been theorized, but little information exists on the heritable variance in common oral and dental disease traits explained by the human genome. We sought to add to the evidence base of heritability of oral and dental traits using high-density genotype data in a well-characterized community-based cohort of middle-age adults. We used genome-wide association (GWAS) data combined with clinical and biomarker information in the Dental Atherosclerosis Risk In Communities (ARIC) cohort. Genotypes comprised SNPs directly typed on the Affymetrix Genome-Wide Human SNP Array 6.0 chip with minor allele frequency of >5% (n = 656,292) or were imputed using HapMap II-CEU (n = 2,104,905). We investigated 30 traits including "global" [e.g., number of natural teeth (NT) and incident tooth loss], clinically defined (e.g., dental caries via the DMFS index, periodontitis via the CDC/AAP and WW17 classifications), and biologically informed (e.g., subgingival pathogen colonization and "complex" traits). Heritability (i.e., variance explained; h²) was calculated using Visscher's Genome-wide Complex Trait Analysis (GCTA), using a random-effects mixed linear model and restricted maximum likelihood (REML) regression adjusting for ancestry (10 principal components), age, and sex. Heritability estimates were modest for clinical traits-NT = 0.11 (se = 0.07), severe chronic periodontitis (CDC/AAP) = 0.22 (se = 0.19), WW17 Stage 4 vs. 1/2 = 0.15 (se = 0.11). "High gingival index" and "high red complex colonization" had h² > 0.50, while a periodontal complex trait defined by high IL-1β GCF expression and Aggregatibacter actinomycetemcomitans subgingival colonization had the highest h² = 0.72 (se = 0.32). Our results indicate that all GWAS SNPs explain modest levels of the observed variance in clinical oral and dental measures. Subgingival bacterial colonization and complex phenotypes encompassing both bacterial colonization and local inflammatory response had the highest heritability, suggesting that these biologically informed traits capture aspects of the disease process and are promising targets for genomics investigations, according to the notion of precision oral health.

Healthy Kids Cambodia - A novel approach to triage for dental care in a population with extreme caries experience

OBJECTIVES

To describe the disease experiences and treatment provided according to a set of novel triage criteria among children in the Healthy Kids Cambodia project.

METHODS

The present study describes the management of caries using the Healthy Kids Cambodia (HKC) strategy at one school in Phnom Penh, Cambodia. Treatment was provided across three levels of care based on a set of simple screening criteria. All children received Level 1 (L1) care, which included application of 30% silver diammine fluoride (SDF) to arrest dental caries. Level 2 (L2) care involved use of atraumatic restorative treatment (ART) and GIC fissure sealants for children between six and eight years of age, and for older children who had one or more cavitated lesions on permanent posterior teeth. Level 3 care involved conventional dental rehabilitation for those children with cavitated lesions in permanent anterior teeth, acute infections, pulpally involved permanent teeth or carious permanent posterior teeth that were not restorable using ART. Three activities were evaluated: (i) screening of all children at the school using the HKC triage criteria; (ii) a detailed re-examination of children in Grades 3 and 4; and (iii) a clinical audit of treatment provided at Level 3 (L3).

RESULTS

1194 children were screened using the HKC approach, and a sample of 304 8- to 12-year-old children was re-examined. Among those who were re-examined, 48 (15.7%) had been referred for L3 treatment and 88 (28.9%) referred for L2 (only). There was a significant difference in baseline caries experience by referral level, whereby those referred to higher levels of care had more severe caries experience. All children in the L3 category required advanced rehabilitative care.

CONCLUSIONS

The application of a triage system by dental students was successful in identifying children in greatest need of complex care (L3). Further research may better validate the system for caries management.

Effectiveness of school dental health education on the oral health status and knowledge of children: A systematic review

Objective

To evaluate the effectiveness of school dental health education on the oral health status, oral health-related knowledge, and practice behavior of 6-12-year-old children.

Methods

Hand search and electronic search based on the keywords on school dental health education in seven search engines till 2017 identified 7434 articles. Trials involving school-based dental health education with a minimum follow-up period of 6 months were screened. Risk of bias assessment was done independently by two authors.

Results

Among the 18 articles which fulfilled the eligibility criteria, six were randomized controlled trials (RCTs) and 12 were non-RCTs. Quality assessment showed that 12 trials had a low risk of bias. Oral health-related knowledge improved in children. Oral health-related practice behaviors such as frequency and duration of brushing improved. Use of fluoridated toothpaste was increased. Plaque scores and gingival bleeding scores reduced.

Conclusion

School dental health education had a positive impact on the oral health status, knowledge, and practice behavior of children. There is a definite need for high-quality RCTs analyzing the effectiveness of school dental health education on specific oral health outcomes.

Experimental mucositis/gingivitis in persons aged 70 or over: microbiological findings and prediction of clinical outcome

OBJECTIVES

To assess in persons aged 70 years or older the microbiological alterations occurring around implants and natural teeth during and after 3 weeks of undisturbed plaque accumulation. Furthermore, to test the predictive value of several markers at baseline for the extent of inflammation around implants and teeth after this period.

MATERIALS AND METHODS

Twenty partially edentulous participants with titanium implants refrained from oral hygiene practices while being clinically monitored in weekly intervals for 21 days. Teeth and implants were then cleaned, oral hygiene resumed, and the participants were further monitored. Levels of six subgingival plaque microorganisms, the plaque index (PI), and the gingival index (GI) were assessed before (baseline), during (days 0, 7, 14, 21), and after plaque accumulation (days 28, 42). Six microorganisms; demographic and clinical variables at day 0 were further evaluated as potential predictors for presence of GI > 1 at days 21 and 28.

RESULTS

The detection frequency of the selected bacteria did not differ between implants and teeth at any time point. Bacteria counts decreased in the preparatory phase and increased in the plaque accumulation phase. Patterns observed at implants and teeth were similar. Only Parvimonas micra at day 21 reached significantly higher counts at implants than teeth. For the prediction of clinical outcome at day 21, in the multivariable model, only implant vs. tooth was significant indicator for the primary outcome (p = 0.01).

CONCLUSIONS

Overall, the analysis of subgingival/submucosal samples revealed only minor differences between implants and teeth during the development and resolution of inflammation.

CLINICAL RELEVANCE

Within the limitations of our study, with plaque accumulation, elders develop more inflammation around implants than around teeth, in spite of similar bacterial profiles.

The Biology of Social Adversity Applied to Oral Health

Biological embodiment is a concept derived from Engel's biopsychosocial model to health, theorized as the process by which adverse social exposures trigger neuroendocrine and immune responses, leading to disease and/or increased disease susceptibility. This critical review discusses the biopsychosocial model as applied to oral health and its relevance to oral health policy while deciphering some of the pathobiological processes underlying social adversity. In periodontal disease, for example, such processes can occur via the activation of the hypothalamic-pituitary-adrenal axis and the consequent release of the chronic stress hormone cortisol. The latter contributes to a proinflammatory immune state that increases the risk for periodontal inflammation. Recent research shows that cortisol relates to an elevated oral inflammatory load, demonstrated as hyperactive neutrophils that are pivotal to periodontal tissue damage. Consistent with the biopsychosocial model, this relationship is amplified in those of lower income and higher financial stress. Similarly, among children from lower socioeconomic backgrounds, cortisol is linked to a higher cariogenic bacterial load. Such findings implicate the stress pathway as key in the oral pathogenic process, particularly under social/socioeconomic adversity. Collectively, this work emphasizes the importance of addressing social factors in alleviating oral disease burden and reducing the social gaps therein.

Promoting parenting strategies to improve tooth brushing in children: design of a non-randomised cluster-controlled trial

Background

Tooth brushing with fluoride toothpaste is a key recommendation in evidence-based guidelines for caries prevention. Parents generally have sufficient knowledge to practice tooth brushing for their child, yet many experience barriers to actually implement the behaviour. Common barriers are associated with difficult child behaviour, stress, poor family organisation and management of routines. These underlying determinants of tooth brushing behaviour should be addressed in caries-preventive interventions.

The ‘Uitblinkers’ intervention is a semi-structured interview method developed for oral healthcare professionals (OHPs), with the aim to improve the practice of twice daily tooth brushing in children. The interview method focusses on ¹⁾ identifying parents’ barriers to tooth brushing, and ²⁾ promoting parenting strategies (related to tooth brushing) to tackle the identified barriers. The intervention applies principles from learning theory, including stimulus control, operant conditioning and authoritative parenting. This paper describes a study protocol to evaluate the effect of the intervention.

Methods

This non-randomised cluster-controlled trial will be conducted in 40 general dental practices in The Netherlands. Intervention practices will implement the intervention in addition to care as usual, while control practices will only provide care as usual. From each dental practice, a random sample of 3 to 4-year-old children will be recruited. The intervention consists of three sessions between an OHP and parent, in which parenting strategies for identified barriers are discussed. The primary study outcome is children’s dental caries experience after 24 months. Secondary outcomes include parents’ self-efficacy in brushing their children’s teeth, tooth brushing frequency in children and children’s dental plaque scores. Differences in outcomes between the intervention and control group will be assessed using logistic and negative binomial regression. The feasibility of the intervention will be assessed through process evaluation.

Discussion

Findings of this study will ascertain whether promoting parenting strategies is a successful method to improve tooth brushing in children and to prevent childhood dental caries in a clinical dental setting.

Trial registration

This trial is registered with the Netherlands National Trial Register (registration date: 7 September 2018; trial registration number: NTR7469).

Electronic supplementary material

The online version of this article (10.1186/s12903-019-0902-6) contains supplementary material, which is available to authorized users.

Ending the neglect of global oral health: time for radical action

Oral diseases are a major global public health problem affecting over 3·5 billion people. However, dentistry has so far been unable to tackle this problem. A fundamentally different approach is now needed. In this second of two papers in a Series on oral health, we present a critique of dentistry, highlighting its key limitations and the urgent need for system reform. In high-income countries, the current treatment-dominated, increasingly high-technology, interventionist, and specialised approach is not tackling the underlying causes of disease and is not addressing inequalities in oral health. In low-income and middle-income countries (LMICs), the limitations of so-called westernised dentistry are at their most acute; dentistry is often unavailable, unaffordable, and inappropriate for the majority of these populations, but particularly the rural poor. Rather than being isolated and separated from the mainstream health-care system, dentistry needs to be more integrated, in particular with primary care services. The global drive for universal health coverage provides an ideal opportunity for this integration. Dental care systems should focus more on promoting and maintaining oral health and achieving greater oral health equity. Sugar, alcohol, and tobacco consumption, and their underlying social and commercial determinants, are common risk factors shared with a range of other non-communicable diseases (NCDs). Coherent and comprehensive regulation and legislation are needed to tackle these shared risk factors. In this Series paper, we focus on the need to reduce sugar consumption and describe how this can be achieved through the adoption of a range of upstream policies designed to combat the corporate strategies used by the global sugar industry to promote sugar consumption and profits. At present, the sugar industry is influencing dental research, oral health policy, and professional organisations through its well developed corporate strategies. The development of clearer and more transparent conflict of interest policies and procedures to limit and clarify the influence of the sugar industry on research, policy, and practice is needed. Combating the commercial determinants of oral diseases and other NCDs should be a major policy priority.

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

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

Oral hygiene interventions for people with intellectual disabilities

BACKGROUND

Periodontal (gum) disease and dental caries (tooth decay) are the most common causes of tooth loss; dental plaque plays a major role in the development of these diseases. Effective oral hygiene involves removing dental plaque, for example, by regular toothbrushing. People with intellectual disabilities (ID) can have poor oral hygiene and oral health outcomes.

OBJECTIVES

To assess the effects (benefits and harms) of oral hygiene interventions, specifically the mechanical removal of plaque, for people with intellectual disabilities (ID).

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the following databases to 4 February 2019: Cochrane Oral Health's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL; Cochrane Register of Studies), MEDLINE Ovid, Embase Ovid and PsycINFO Ovid. ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. The Embase search was restricted by date due to the Cochrane Centralised Search Project, which makes available clinical trials indexed in Embase through CENTRAL. We handsearched specialist conference abstracts from the International Association of Disability and Oral Health (2006 to 2016).

SELECTION CRITERIA

We included randomised controlled trials (RCTs) and some types of non-randomised studies (NRS) (non-RCTs, controlled before-after studies, interrupted time series studies and repeated measures studies) that evaluated oral hygiene interventions targeted at people with ID or their carers, or both. We used the definition of ID in the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10). We defined oral hygiene as the mechanical removal of plaque. We excluded studies that evaluated chemical removal of plaque, or mechanical and chemical removal of plaque combined.

DATA COLLECTION AND ANALYSIS

At least two review authors independently screened search records, identified relevant studies, extracted data, assessed risk of bias and judged the certainty of the evidence according to GRADE criteria. We contacted study authors for additional information if required. We reported RCTs and NRSs separately.

MAIN RESULTS

We included 19 RCTs and 15 NRSs involving 1795 adults and children with ID and 354 carers. Interventions evaluated were: special manual toothbrushes, electric toothbrushes, oral hygiene training, scheduled dental visits plus supervised toothbrushing, discussion of clinical photographs showing plaque, varied frequency of toothbrushing, plaque-disclosing agents and individualised care plans. We categorised results as short (six weeks or less), medium (between six weeks and 12 months) and long term (more than 12 months).Most studies were small; all were at overall high or unclear risk of bias. None of the studies reported quality of life or dental caries. We present below the evidence available from RCTs (or NRS if the comparison had no RCTs) for gingival health (inflammation and plaque) and adverse effects, as well as knowledge and behaviour outcomes for the training studies.Very low-certainty evidence suggested a special manual toothbrush (the Superbrush) reduced gingival inflammation (GI), and possibly plaque, more than a conventional toothbrush in the medium term (GI: mean difference (MD) -12.40, 95% CI -24.31 to -0.49; plaque: MD -0.44, 95% CI -0.93 to 0.05; 1 RCT, 18 participants); brushing was carried out by the carers. In the short term, neither toothbrush showed superiority (GI: MD -0.10, 95% CI -0.77 to 0.57; plaque: MD 0.20, 95% CI -0.45 to 0.85; 1 RCT, 25 participants; low- to very low-certainty evidence).Moderate- and low-certainty evidence found no difference between electric and manual toothbrushes for reducing GI or plaque, respectively, in the medium term (GI: MD 0.02, 95% CI -0.06 to 0.09; plaque: standardised mean difference 0.29, 95% CI -0.07 to 0.65; 2 RCTs, 120 participants). Short-term findings were inconsistent (4 RCTs; low- to very low-certainty evidence).Low-certainty evidence suggested training carers in oral hygiene care had no detectable effect on levels of GI or plaque in the medium term (GI: MD -0.09, 95% CI -0.63 to 0.45; plaque: MD -0.07, 95% CI -0.26 to 0.13; 2 RCTs, 99 participants). Low-certainty evidence suggested oral hygiene knowledge of carers was better in the medium term after training (MD 0.69, 95% CI 0.31 to 1.06; 2 RCTs, 189 participants); this was not found in the short term, and results for changes in behaviour, attitude and self-efficacy were mixed.One RCT (10 participants) found that training people with ID in oral hygiene care reduced plaque but not GI in the short term (GI: MD -0.28, 95% CI -0.90 to 0.34; plaque: MD -0.47, 95% CI -0.92 to -0.02; very low-certainty evidence).One RCT (304 participants) found that scheduled dental recall visits (at 1-, 3- or 6-month intervals) plus supervised daily toothbrushing were more likely than usual care to reduce GI (pocketing but not bleeding) and plaque in the long term (low-certainty evidence).One RCT (29 participants) found that motivating people with ID about oral hygiene by discussing photographs of their teeth with plaque highlighted by a plaque-disclosing agent, did not reduce plaque in the medium term (very low-certainty evidence).One RCT (80 participants) found daily toothbrushing by dental students was more effective for reducing plaque in people with ID than once- or twice-weekly toothbrushing in the short term (low-certainty evidence).A benefit to gingival health was found by one NRS that evaluated toothpaste with a plaque-disclosing agent and one that evaluated individualised oral care plans (very low-certainty evidence).Most studies did not report adverse effects; of those that did, only one study considered them as a formal outcome. Some studies reported participant difficulties using the electric or special manual toothbrushes.

AUTHORS' CONCLUSIONS

Although some oral hygiene interventions for people with ID show benefits, the clinical importance of these benefits is unclear. The evidence is mainly low or very low certainty. Moderate-certainty evidence was available for only one finding: electric and manual toothbrushes were similarly effective for reducing gingival inflammation in people with ID in the medium term. Larger, higher-quality RCTs are recommended to endorse or refute the findings of this review. In the meantime, oral hygiene care and advice should be based on professional expertise and the needs and preferences of the individual with ID and their carers.

A public health perspective on personalized periodontics

In this paper, we consider personalized periodontics from a public health perspective. Periodontitis is an under-acknowledged and important public health problem, and there has long been interest in identifying and treating those who are at high risk of developing this disease. Although susceptibility/risk-assessment tools in periodontology are currently in their early stages of development, personalized periodontics is increasingly becoming a realistic approach. At the population level, however, personalized periodontics is not an effective way of improving periodontal health because it would target only those who seek help or are able to access care. The occurrence of periodontitis in populations is socially patterned, with those of lower socio-economic position having poorer periodontal health and being far less likely to seek care. There is the potential for social inequalities actually to worsen as a result of personalized periodontics. In most health systems, personalized periodontics is likely to be accessible only to the social strata for whom it is affordable, and those with the greatest need for such an intervention will remain the least likely to be able to get it. Thus, personalized periodontics is likely to be a niche service for a small proportion of the adult population. This is at odds with the public health approach.