Factors associated with parents? and adolescents? perceptions of oral health and need for dental treatment

Oral habits, sociopsychological orthodontic needs, and sociodemographic factors perceived by caregivers impact oral health-related quality of life in children with and without autism?

BACKGROUND

Caregivers play a crucial role in assessing the oral health-related quality of life (OHRQoL) of young individuals with autism spectrum disorder (ASD).

AIM

This study assessed the impact of sociodemographic and oral conditions on OHRQoL and family dynamics in young individuals with and without autism, as perceived by guardians.

DESIGN

This comparative cross-sectional study included young individuals aged 6 to 14 years and their guardians. Data were collected at a specialized institution and dental schools. Guardians completed the Parental-Caregiver Perceptions Questionnaire (P-CPQ), Family Impact Scale (FIS), and sociodemographic and oral habits questionnaires. The sociopsychological need for orthodontic treatment was assessed using the Index of Orthodontic Treatment Need (IOTN).

RESULTS

The sample included 144 youths and caregivers. The ASD group had higher P-CPQ and FIS scores. Factors associated with poorer perceived OHRQoL included higher youth age, lower caregiver education, higher IOTN scores, teeth clenching (RR = 1.20; 95% CI: 1.01-1.41), and lip sucking. Lower parental education (RR = 1.75; 95% CI: 1.10-2.80) and higher IOTN scores from the caregiver's perspective impacted family dynamics.

CONCLUSION

Caregivers of young individuals with ASD perceived a lower OHRQoL, and families in this group were more affected by sociodemographic and oral conditions.

Evaluating the harmonization potential of oral health-related questionnaires in national longitudinal birth and child cohort surveys

BACKGROUND/OBJECTIVES

Effective use of longitudinal study data is challenging because of divergences in the construct definitions and measurement approaches over time, between studies and across disciplines. One approach to overcome these challenges is data harmonization. Data harmonization is a practice used to improve variable comparability and reduce heterogeneity across studies. This study describes the process used to evaluate the harmonization potential of oral health-related variables across each survey wave.

METHODS

National child cohort surveys with similar themes/objectives conducted in the last two decades were selected. The Maelstrom Research Guidelines were followed for harmonization potential evaluation.

RESULTS

Seven nationally representative child cohort surveys were included and questionnaires examined from 50 survey waves. Questionnaires were classified into three domains and fifteen constructs and summarized by age groups. A DataSchema (a list of core variables representing the suitable version of the oral health outcomes and risk factors) was compiled comprising 42 variables. For each study wave, the potential (or not) to generate each DataSchema variable was evaluated. Of the 2100 harmonization status assessments, 543 (26%) were complete. Approximately 50% of the DataSchema variables can be generated across at least four cohort surveys while only 10% (n = 4) variables can be generated across all surveys. For each survey, the DataSchema variables that can be generated ranged between 26% and 76%.

CONCLUSION

Data harmonization can improve the comparability of variables both within and across surveys. For future cohort surveys, the authors advocate more consistency and standardization in survey questionnaires within and between surveys.

Perception of parents and caregivers about the need for dental appointments for adolescents from a Brazilian birth cohort

OBJECTIVE

To investigate the perception of parents or caregivers regarding the need for dental appointments for adolescents aged 12-13 years and associated factors.

METHODS

Data from the Pelotas 2004 Birth Cohort were used. The outcome variable was the need for dental appointments for young adolescents perceived by parents or caregivers. Demographic and economic exposure variables were obtained from the first (2004) and sixth general follow-up (2015), respectively. The exposure variables 'previous history of dental pain', 'self-rated oral health', clinical variables and the outcome variable were obtained from the second oral health follow-up (2017). Unadjusted and adjusted multivariate Poisson regression analyses provided prevalence ratios (PR) and respective 95% confidence intervals (CI).

RESULTS

At the first oral health follow-up (2009), 1303 five-year-old children were recruited, 996 of whom were reassessed and underwent oral health examinations at 12 and 13 years of age (response rate: 76.4%). The findings showed that 72.4% of parents/caregivers perceived that the adolescents needed dental appointments. No associations were found between the outcome and sociodemographic or economic variables. After adjustments, the outcome remained positively associated with previous history of toothache (PR 1.22; 95% CI 1.14-1.32), self-rated oral health as fair or poor (PR 1.26; 95% CI 1.15-1.39), the presence of dental caries (PR 1.27; 95% CI 1.20-1.38) and severe or disabling malocclusion (PR 1.14; 95% CI 1.05-1.25).

CONCLUSIONS

The perception of parents/caregivers regarding the need for dental appointments on the part of their adolescent sons and daughters was associated with oral health problems, and these findings can serve as the basis for creating and improving oral health programmes that seek a better understanding on the part of parents and caregivers regarding the importance of integral care for their adolescent children.

Water fluoridation, dental caries and parental ratings of child oral health

OBJECTIVES

Previous studies have identified many demographic, socioeconomic, behavioural and clinical variables associated with subjective parental ratings of child oral health. This study investigated associations between children's lifetime exposure to fluoridated drinking water (LEFW) and dental caries prevalence and parental ratings.

METHODS

Australia's National Child Oral Health Study 2012-2014 conducted oral epidemiological examinations for 24 664 children aged 5-14 and investigated risk factors for child oral health and disease through questionnaires. Parents also subjectively rated their child's oral health. This cross-sectional study estimated prevalence ratios for associations between LEFW and prevalence of dental caries in the primary and permanent dentitions and parental oral health ratings for 5-8 year old and 9-14 year old children. E-value sensitivity analyses helped assess whether observed effect sizes may have arisen through unmeasured confounding.

RESULTS

Children aged 5-8 with 0%-10% or 11%-89% LEFW are respectively 1.5 (95% CI 1.2-1.8) and 1.5 (95% CI 1.1-2.0) times more likely than children with 90%-100% LEFW to receive a fair or poor parental oral health rating. Children aged 9-14 with 0%-10% or 11%-89% LEFW are 1.2 (95% CI 1.0-1.4) times more likely than children with 90%-100% LEFW to receive a fair or poor parental oral health rating. Children aged 5-8 with 0%-10% or 11%-89% LEFW are respectively 1.4 (1.3-1.6) and 1.3 (95% CI 1.1-1.4) times more likely than children with 90%-100% LEFW to experience caries in their primary teeth. Children aged 9-14 with 0%-10% or 11%-89% LEFW are respectively 1.4 (95% CI 1.3-1.5) and 1.1 (95% CI 1.0-1.2) times more likely than children with 90%-100% LEFW to experience caries in their permanent teeth.

CONCLUSIONS

Longer lifetime exposure to fluoridated drinking water is causally associated with a lower childhood dental caries prevalence and more positive parental ratings of child oral health. The associations are stronger for younger children.

Health Professionals Oral Health Knowledge and Practice: Unleashing the Hidden Challenges

Objective

Dental disease is one of the major prevalent preventable public health challenges that resulted in a significant burden on children and adults. The aim of the current study was to identify oral health-related knowledge and practice among Bahir Dar community health care providers and the perceived barriers to oral health care services.

Methods

A cross-sectional study was conducted. A self-administered, structured questionnaire was used for data collection, and SPSS version 20 was used for data analysis. A chi-square test was used to determine the association between study variables, and a P-value of less than 0.05 was considered to declare statistical significance.

Results

A total of 281 interviews were conducted. Doctors had the highest mean knowledge score value of 4.67 followed by dentists with a mean score of 4.5. The majority of the study participants (59.4%) reported that they use a toothbrush and fluoride toothpaste for brushing their teeth, and a statistically significant difference was observed between different types of health professionals. The majority of the study participants (80.1 and 70.8%) reported limited finances and lack of adequate health/dental insurance as a barrier to oral health care services, respectively.

Conclusion

Oral health-related knowledge of health professionals in Bahir Dar city is low. Oral health topics must be incorporated into the health care professionals training programs and continuing medical education. Health professionals should master basic oral health-related knowledge, and they should practice basic oral health care practices to become role models for their patients.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

A Causative Approach to Demographic and Socioeconomic Factors Affecting Parental Ratings of Child Oral Health

INTRODUCTION

Many studies have investigated associations between demographic, socioeconomic status (SES), behavioral, and clinical factors and parental ratings of child oral health. Caries experience, pain, missing teeth, malocclusions, and conditions and treatments likely to negatively affect the child or family in the future have been consistently associated with poorer parental ratings. In contrast, effect sizes for associations between demographic and SES indicators (race/ethnicity, country of birth, family structure, household income, employment status, and parental education levels) and parental ratings vary greatly.

OBJECTIVES

The primary objectives of this study were to estimate effect sizes for associations between demographic and SES variables and parental ratings of child oral health and then to consider possible causal implications.

METHODS

This article uses a nationally representative data set from 24,664 Australian children aged 5 to 14 y, regression analyses guided by a directed acyclic graph causal model, and sensitivity analyses to investigate effects of demographic and SES factors on parental ratings of oral health.

RESULTS

One in 8 children had oral health rated as fair or poor by a parent. Indigenous children, older boys, young children with a migrant parent, children from single-parent families, low-income households and families where no parent worked full-time, and children whose parents had lower education levels were much more likely to receive a fair or poor parental oral health rating in crude and adjusted models.

CONCLUSION

This cross-sectional study helps to clarify inconsistent findings from previous research and shows many demographic and SES variables to be strong determinants of parental ratings of child oral health, consistent with the effects of these variables on other health outcomes. Sensitivity analyses and consideration of the potential for chance and bias to have affected these findings suggest that many of these associations may be causal.

KNOWLEDGE TRANSFER STATEMENT

Based on regression analyses driven by a directed acyclic graph causal model, this research shows a strong impact of demographic and socioeconomic determinants on parental ratings of child oral health, consistent with associations between these variables and other oral and general health outcomes. Many of these associations may be causal. We demonstrate the value of causal models and causal thinking when analyzing complex multilevel observational data.

Association between a child's caries experience and the mother's perception of her child's oral health status

BACKGROUND

Mothers play a primary role in the health of their children. This role may be of particular importance for children in Appalachia who have increased caries relative to children in other regions of the United States. The authors examined the degree to which a child's caries experience was in concordance with the mother's perception of the health of her child's teeth, and how concordance varied by sociodemographic factors.

METHODS

The authors obtained cross-sectional data on mother-child dyads with children younger than 6 years through the Center for Oral Health Research in Appalachia study. They interviewed and clinically examined a community-based sample of 815 mother-child dyads from Pennsylvania and West Virginia. They used an unadjusted zero-inflated negative binomial model to estimate the association between a mother's perception of her child's oral health status and her child's caries. The authors compared sociodemographic factors between concordant and nonconcordant mother-child dyads using χ² tests.

RESULTS

The mother's perception of her child's oral health status was associated with the child's caries experience (P < .001). Two-thirds of mother-child dyads showed concordance between the mother's perception of her child's oral health status and the child's caries experience (n = 522, 64%). Concordance was associated with younger child age and the child having dental insurance (P < .01).

CONCLUSIONS AND PRACTICAL IMPLICATIONS

On average, mothers accurately perceived their child's caries experience. This accuracy was higher for younger children and children with dental insurance. The mother's awareness of her child's oral health status could be used to develop effective prevention and treatment strategies, particularly for young children vulnerable to caries.

Development of toolkits for detecting dental caries and caries experience among children using self-report and parent report

OBJECTIVES

To develop child- and parent-reported toolkits for active caries and caries experience in children and adolescents, ages 8-17.

METHODS

A sample of 398 child/parent dyads recruited from 12 dental practices in Los Angeles County completed a computer-assisted survey that assessed oral health perceptions. In addition, children received a dental examination that identified the presence or absence of active caries and caries experience. A Multiple Adaptive Regression Splines model was used to identify a subset of survey items associated with active caries and caries experience. The splines and coefficients were refined by generalized cross-validation. Sensitivity and specificity for both dependent variables were evaluated.

RESULTS

Eleven child self-reported items were identified that had sensitivity of 0.82 and specificity of 0.45 relative to active caries. Twelve parent-reported items had a sensitivity of 0.86 and specificity of 0.50. Seven child self-reported items had a sensitivity of 0.86 and specificity of 0.34, and 11 parent-reported items had a sensitivity of 0.86 and specificity of 0.47 for caries experience.

CONCLUSIONS

The survey items identified here are useful in distinguishing children with and without active caries and with and without caries experience. This research presents a path towards using children's and their parents' reports about oral health to screen for clinically determined caries and caries exposure. The items identified in this study can be useful when clinical information is unavailable.

The Impact of Policy Modifiable Factors on Inequalities in Rates of Child Dental Caries in Australia

Background: Poor oral health in childhood can lead to adverse impacts later in life. We aimed to estimate the prevalence and population distribution of childhood dental caries in Australia and investigate factors that might ameliorate inequalities. Methods: Data from the nationally representative birth cohort Longitudinal Study of Australian Children (N = 5107), using questions assessing: The experience of dental caries during each biennial follow-up period (2–3 years to 10–11 years), socioeconomic position (SEP), and policy modifiable oral health factors. Results: The odds of dental caries were higher for children with lowest vs. highest SEP (adjusted OR (adjOR) 1.92, 95% CI 1.49–2.46), and lower where water was fluoridated to recommended levels (adjOR 0.53, 95% CI 0.43–0.64). There was no evidence of an association between caries experience and either reported sugary diet or tooth brushing. When SEP and fluoridation were considered in conjunction, compared to the highest SEP group with water fluoridation children in the lowest SEP with fluoridation had adjOR 1.54 for caries, (95% CI 1.14–2.07), and children in the lowest SEP without fluoridation had adjOR 4.06 (95% CI 2.88–5.42). For patterns of service use: The highest SEP group reported a greater percentage of service use in the absence of caries. Conclusions: Dental caries appears prevalent and is socially distributed in Australia. Policy efforts should consider how to ensure that children with dental caries receive adequate prevention and early care with equitable uptake.

The oral health behaviours and fluid consumption practices of young urban Aboriginal preschool children in south-western Sydney, New South Wales, Australia

ISSUE ADDRESSED

Australian Aboriginal children have a higher risk of dental caries yet there is limited focus on oral health risk factors for urban Aboriginal preschool children. This study examined the oral health behaviours and fluid consumption practices of young children from an urban Aboriginal community in south-western Sydney, Australia.

METHODS

In total, 157 Aboriginal children who were recruited to the "Gudaga" longitudinal birth cohort participated in this study. A survey design was employed and parents responded to the oral health questions when their child was between 18 and 60 months.

RESULTS

Few parents (20%) were concerned about their child's oral health across the time period. By 60 months, only 20% of children had seen a dentist while 80% were brushing their teeth at least once daily. High levels of bottle use were seen up to 30 months. Consumption of sugary drinks was also very high in the early years, although this was replaced by water by 36 months.

CONCLUSIONS

While there are some encouraging findings, such as the rates of tooth brushing and increasing rates of water consumption, the findings do highlight the poor uptake of dental services and high levels of bottle usage among urban aboriginal children during their early years. SO WHAT?: Targeted oral health promotional programs are needed in the urban Aboriginal community to better support parents understanding of good oral health practices in the early years and engagement with dental health services.

The effect of health and dental insurance on US children's dental care utilization for urgent and non-urgent dental problems - 2008

OBJECTIVE

We examined the association between utilization of care for a dental problem (utilization-DP) and parent-reported dental problem (DP) urgency among children with DP by type of health care insurance coverage.

METHODS

We used weighted 2008 National Health Interview Survey data from 2,834 children, aged 2-17 years with at least one DP within the 6 months preceding survey. Explanatory variables were selected based on Andersen's model of healthcare utilization. Need was considered urgent if DP included toothache, bleeding gums, broken or missing teeth, broken or missing filling, or decayed teeth and otherwise as non-urgent. The primary enabling variable, insurance, had four categories: none, private health no dental coverage (PHND), private health and dental (PHD), or Medicaid/State Children's Health Insurance Program (SCHIP). Predisposing variables included sociodemographic characteristics. We used bivariate and multivariate analyses to identify explanatory variables' association with utilization-DP. Using logistic regression, we obtained adjusted estimates of utilization-DP by urgency for each insurance category.

RESULTS

In bivariate analyses, utilization-DP was associated with both insurance and urgency. In multivariate analyses, the difference in percent utilizing care for an urgent versus non-urgent DP among children covered by Medicaid/SCHIP was 32 percentage points; PHD, 25 percentage points; PHND, 12 percentage points; and no insurance, 14 percentage points. The difference in utilization by DP urgency was higher for children with Medicaid/SCHIP compared with either PHND or uninsured children.

CONCLUSION

Expansion of Medicaid/SCHIP may permit children to receive care for urgent DPs who otherwise may not, due to lack of dental insurance.

Increased public reimbursement for prophylactic visits with dentists associated with increased receipt of preventive dental services in children

OBJECTIVE

To determine whether higher reimbursement for children's preventive dentistry correlates with greater utilization of preventive dental care.

METHODS

A cross-sectional analysis of National Survey of Children's Health 2011/2012 was conducted, combined with state Medicaid reimbursement rates for preventive dentistry. Analyses included prevalence, unadjusted odds ratios, and multivariable logistic regression for receipt of preventive dental services.

RESULTS

Of all surveyed American children 1-17 years, almost 20 percent had not received preventive dental care in prior year; this percentage is even higher in those with public insurance. Each $10 increase in state reimbursement was associated with a 17 percent decrease in odds of children not receiving preventive services.

CONCLUSIONS

Higher state reimbursement for preventive services may increase children's receipt of preventive dental care.

Parental awareness and dental attendance of children among African immigrants

To assess parental awareness of their child's dental status and the relationship between parental awareness and children's dental attendance. Participants were children aged 6 years or younger and their African parents who had lived in Canada for up to 10 years. Demographics and parents' perceived dental status were collected. Children's normative dental status was determined by dental examinations. 125 pairs of parents and children aged 21-72 months were included. 52% of the children never had a dental visit. Dental status of 44% of children was rated as good by parents, among them, 56% had dental decay. Parental assessments did not coincide with the clinical assessments of 62% of children. No correlation was found between parental awareness and children's dental attendance. Children of African immigrants are at high risk for developing severe dental decay because of low parental awareness and lack of regular dental visits.

Impact of molar-incisor hypomineralization on oral health-related quality of life in schoolchildren

This study evaluated the impact of molar-incisor hypomineralization (MIH) on oral health-related quality of life (OHRQoL) according to the perceptions of schoolchildren and their parents/caregivers. This cross-sectional study consisted of a sample of 594 schoolchildren between 11 and 14 years of age and their parents/caregivers who answered the questionnaires CPQ11-14ISF:16 and P-CPQ, respectively. The main independent variable of this study was MIH of the schoolchildren. Experience of dental caries, malocclusion, and socioeconomic status were treated as confounding variables. Statistical analysis used descriptive analysis and Poisson regression with robust variance. The prevalence of MIH was 18.9%. The overall P-CPQ score ranged from 0 to 35 (average = 7.26 ± 6.84), and the overall CPQ11-14ISF:16 score ranged from 0 to 47 (average = 11.92 ± 7.98). Severe MIH was associated with a greater negative impact of the "functional limitation" domain (RR = 1.41; 95%CI = 1.01-1.97), according to parents'/caregivers' perceptions. Severe MIH was associated with a greater negative impact of the "oral symptom" domain (RR = 1.30; 95%CI = 1.06-1.60) and functional limitation domain (RR = 1.42; 95%CI = 1.08-1.86), according to the schoolchildren's perceptions. Schoolchildren with severe MIH had a greater negative impact on the oral symptom and functional limitation domains than those without MIH. According to parents'/caregivers' perceptions, schoolchildren with severe MIH had a greater negative impact on the functional limitation domain than those without MIH.

Perceptions of oral health, preventive care, and care-seeking behaviors among rural adolescents

BACKGROUND

An asymmetrical oral disease burden is endured by certain population subgroups, particularly children and adolescents. Reducing oral health disparities requires understanding multiple oral health perspectives, including those of adolescents. This qualitative study explores oral health perceptions and dental care behaviors among rural adolescents.

METHODS

Semistructured individual interviews with 100 rural, minority, low socioeconomic status adolescents revealed their current perceptions of oral health and dental care access. Respondents age ranged from 12 to 18 years. The sample was 80% black and 52% male.

RESULTS

Perceived threat from dental disease was low. Adolescents perceived regular brushing and flossing as superseding the need for preventive care. Esthetic reasons were most often cited as reasons to seek dental care. Difficulties accessing dental care include finances, transportation, fear, issues with Medicaid coverage and parental responsibility. In general, adolescents and their parents are in need of information regarding the importance of preventive dental care.

CONCLUSIONS

Findings illuminate barriers to dental care faced by low-income rural adolescents and counter public perceptions of government-sponsored dental care programs as being "free" or without cost. The importance of improved oral health knowledge, better access to care, and school-based dental care is discussed.

Factors associated with dental caries experience and oral health status among New South Wales adolescents

OBJECTIVE

To investigate the potential social and behavioural risk factors influencing the oral health of teenagers aged 14 and 15 years living in New South Wales Australia.

METHODS

Quantitative and qualitative methodologies were used in this research project. Data were obtained from both the clinical and questionnaire components of the NSW Teen Dental Survey 2010 and were analysed in SAS 9.2. The analyses allowed for various demographic and behavioural risk factors to be assessed using caries experience, severe caries and DMFT (decayed, missing or filled teeth) counts as the key outcome variables.

RESULTS

Of the 1,256 14- and 15-year-olds who had a dental examination, 1,199 (95.5%) provided questionnaire data. The clinical examinations found that 44.4% of teenagers overall had caries experience in at least one tooth, while 10.6% of the sample had experienced severe caries. Severe dental caries was found to be significantly related to a variety of factors, including family income, fluoridation status, tooth brushing behaviour and sugary drink consumption.

CONCLUSIONS

The oral health of 14- and 15-year-olds in NSW is influenced by social and dietary factors as well as access to fluoridated water supplies. There was also a strong relationship between self-rated oral health status with DMFT and with caries experience.

IMPLICATIONS

The findings of this study will assist policy makers by highlighting the current caries risk factors that should be part of future health promotion programs.

Children's dental health, school performance, and psychosocial well-being

OBJECTIVE

To assess the effects of dental health on school performance and psychosocial well-being in a nationally representative sample of children in the US.

STUDY DESIGN

We analyzed data from the 2007 National Survey of Children's Health for 40,752-41,988 children. The effects of dental problems and maternal-rated dental health on school performance and psychosocial well-being outcomes were evaluated using regression models adjusting for demographic, socioeconomic, and health characteristics.

RESULTS

Dental problems were significantly associated with reductions in school performance and psychosocial well-being. Children with dental problems were more likely to have problems at school (OR = 1.52; 95% CI: 1.37-1.72) and to miss school (OR = 1.42; 95% CI: 1.23-1.64) and were less likely to do all required homework (OR = 0.76; 95% CI: 0.68-0.85). Dental problems were associated with shyness, unhappiness, feeling of worthlessness, and reduced friendliness. The effects of dental problems on unhappiness and feeling of worthlessness were largest for adolescents between 15 and 17 years.

CONCLUSION

Preventing and treating dental problems and improving dental health may benefit child academic achievement and cognitive and psychosocial development.

Validation of the Parental-Caregiver Perceptions Questionnaire: agreement between parental and child reports

OBJECTIVES

To test the validity and reliability of Brazilian Portuguese version of the Parental-Caregiver Perceptions Questionnaire (P-CPQ) (Aim 1) and to assess the agreement between parents and children concerning the child's oral health-related quality of life (OHRQoL) (Aim 2).

METHODS

The P-CPQ and the Brazilian Portuguese versions of the Child Perceptions Questionnaires (CPQ8-10 and CPQ11-14 ) were used. Objective 1 addressed in the study that involved 210 (validity and internal reliability) and 20 (test-retest reliability) parents and Objective 2 in the study that involved 210 pairs of parents and children. Construct validity was calculated using the Spearman's correlation and the Mann-Whitney/Kruskal-Wallis tests. Reliability was determined using Cronbach's alpha and intraclass correlation coefficient (ICC). Agreement between overall and subscale scores derived from the P-CPQ and CPQ was assessed in comparison and correlation analyses.

RESULTS

The P-CPQ discriminated among the categories of malocclusion and dmft. The P-CPQ showed good construct validity, good internal consistency reliability, and excellent test-retest reliability. There was systematic under- and overreporting in parents' assessments for younger and older children, respectively. However, the magnitude of the directional differences was just small. At individual level, agreement between parents and children was excellent. However, it ranged from excellent to moderate or substantial in subscales for CPQ8-10 and CPQ11-14 groups, respectively.

CONCLUSIONS

The Portuguese version of P-CPQ is valid and reliable. Some parents have limited knowledge about child OHRQoL. Given that parental and child reports measure different realities concerning the child's OHRQoL, information provided by parents can complement the child's evaluation.

An examination of racial/ethnic disparities in children's oral health in the United States

OBJECTIVE

To assess the extent factors other than race/ethnicity explain apparent racial/ethnic disparities in children's oral health and oral health care.

METHODS

Data were from the 2007 National Survey of Children's Health, for children 2-17 years (n=82,020). Outcomes included parental reports of child's oral health status, receiving preventive dental care, and delayed dental care/unmet need. Model-based survey-data-analysis examined racial/ethnic disparities, controlling for child, family, and community/state (contextual) factors.

RESULTS

Unadjusted results show large racial/ethnic oral health disparities. Compared with non-Hispanic White people, Hispanic and non-Hispanic-Black people were markedly more likely to be reported in only fair/poor oral health [odds ratios (ORs) (95% confidence intervals) 4.3 (4.0-4.6), 2.2 (2.0-2.4), respectively], lack preventive care [ORs 1.9 (1.8-2.0), 1.4 (1.3-1.5)], and experience delayed care/unmet need [ORs 1.5 (1.3-1.7), 1.4 (1.3-1.5)]. Adjusting for child, family, and community/state factors reduced racial/ethnic disparities. Adjusted ORs (AORs) for Hispanics and non-Hispanic Blacks attenuated for fair/poor oral health, to 1.6 (1.5-1.8) and 1.2 (1.1-1.4), respectively. Adjustment eliminated disparities for lacking preventive care [AORs 1.0 (0.9-1.1), 1.1 (1.1-1.2)] and in Hispanics for delayed care/unmet need (AOR 1.0). Among non-Hispanic Blacks, adjustment reversed the disparity for delayed care/unmet need [AOR 0.6 (0.6-0.7)].

CONCLUSIONS

Racial/ethnic disparities in children's oral health status and access were attributable largely to socioeconomic and health insurance factors. Efforts to decrease disparities may be more efficacious if targeted at social, economic, and other factors associated with minority racial/ethnic status and may have positive effects on all who share similar social, economic, and cultural characteristics.

State-level differences in the oral health of Australian preschool and early primary school-age children

BACKGROUND

This study compares oral health outcomes and behaviours for young Australian children by residential state or territory to determine whether state differences arise from individual exposures to risk factors.

METHODS

Cross-sectional data for 4606 2-3 year olds and 4464 6-7 year olds were obtained from the Longitudinal Study of Australian Children. Outcome measures were parent-reports of children's caries experience, frequency of toothbrushing and dental services use.

RESULTS

For 2-3 year olds, children from the Australian Capital Territory were less likely to have parent-reported caries than children from other states, and more likely to brush their teeth twice daily and to have used dental services. For 6-7 year olds, optimal outcomes were observed in New South Wales for lowest caries experience, Western Australia for highest toothbrushing, and South Australia for highest dental services use. Adjustments for socio-demographic predictors did not eliminate state differences in oral health.

CONCLUSIONS

  Large state differences in the oral health of young children persisted after adjustment for individual socio-demographic determinants, suggesting these arise from variations in the systems to promote and care for children's oral health. Several states would benefit from a stronger emphasis on oral health promotion in young children, and disparities from a young age suggest the need for better engagement of early childhood professionals in oral health promotion.

Oral Health Knowledge and Behaviors among Adolescents with Type 1 Diabetes

Early onset and more advanced periodontal disease has been reported for children with diabetes. We surveyed oral health knowledge, attitudes, and behaviors among adolescents with diabetes in order to inform potential intervention strategies. Study subjects were youth (ages 12–19 years) with type 1 diabetes (N = 90) participating in a cohort study investigating determinants of periodontal disease at a regional pediatric diabetes specialty clinic. Over 90% of the youth had been instructed on how to brush and floss and had preventive dental care in the past year. However, 44% knew that periodontal disease is associated with diabetes and 32% knew that it can start in childhood with bleeding gums. Despite being at high risk for developing periodontal disease, the mean toothbrushing frequency was once per day and 42% did not floss. Significant opportunity exists for improving periodontal disease knowledge and adoption of preventive oral hygiene behaviors in adolescents with diabetes.

Factors associated with caregivers' perception of children's health and oral health status: a study of 6- to 36-month-olds in Uganda

BACKGROUND

The impact of oral diseases on quality of life of children and their families has not been thoroughly investigated.

AIM

Focusing on Ugandan infants aged 6-36 months and their caregivers, this study examined the degree to which clinical and psychosocial factors were associated with caregivers' overall evaluation of their children's oral health and health status.

DESIGN

Eight hundred and sixteen children were examined for dental caries and anthropometric status in 2007. A questionnaire was completed by the caregivers.

RESULTS

Poor child oral health was reported by 40.2% and 17.5% of caregivers who reported their children's health as, respectively, poor and good. Having the least family wealth [odds ratio (OR) = 1.9] and reporting distressed family activities (OR = 2.3) were associated with higher odds of reporting poor child oral health, whereas being a rural resident (OR = 0.4) and reporting no symptoms during tooth eruption (OR = 0.3) were associated with lower odds. Perception of poor child oral health (OR = 2.8) and having the least family wealth (OR = 1.7) were associated with higher odds of reporting poor child health status, whereas no stunting was associated with lower odds (OR = 0.5).

CONCLUSION

The results support the growing recognition of oral health as a predictor of health and well-being in early childhood.

Factors influencing perception of oral health among adolescents in Sri Lanka

AIM

To determine factors associated with perceived oral health status among adolescents in Sri Lanka.

DESIGN

A descriptive, cross-sectional study where the data were collected by means of an oral examination and questionnaires to both children and their parents.

SETTING

Schools in the Colombo district, Sri Lanka.

PARTICIPANTS

1,218, 15-year-old adolescents who were selected from 48 schools using a stratified cluster sampling techniques.

RESULTS

Nearly 21% of the sample rated their oral health as poor. According to the hierarchical logistic regression models the percentage of variance in perceived oral health explained by the four groups of independent variables namely: socio-demographic variables, oral health behaviours, clinical oral health indicators and subjective measures of oral health status were 3, 1, 4 and 7% respectively. The final model indicated that poor perceived oral health was significantly associated with low household income, not using dental services, presence of gingivitis, being aware about the presence of oral disease, presence of toothache and other oral symptoms and perceived need for dental care. It accounted for 15% of the variation in perceived oral health.

CONCLUSIONS

Subjective measures of oral health contributed most to the single-item perceived oral health rating of adolescents. Socio-demographic variables and normative measures of untreated caries, missing teeth and gingivitis had a limited role in explaining perceived oral health in Sri Lankan adolescents.

Measuring parental-caregiver perceptions of child oral health-related quality of life

The Parental-Caregiver Perceptions Questionnaire (P-CPQ) is an instrument that assesses a parent's or a caregiver's perceptions regarding the impact of children's oral health status on quality of life. The aim of this study was to evaluate the psychometric properties of the Brazilian version of the P-CPQ. Following translation and cross-cultural adaptation, the P-CPQ was tested on 123 parents and caregivers of children between 11 and 14 years of age with dental caries and malocclusions. The parents/caregivers were recruited at dental clinics of the Federal University of Minas Gerais, where their children were receiving dental care. Psychometric properties were assessed through internal consistency, test-retest reliability, construct validity and discriminant validity. The mean P-CPQ score was 13.01 (SD=12.14) for the dental caries group and 16.57 (SD=13.13) for the malocclusion group. Internal reliability was confirmed by a Cronbach's alpha coefficient of 0.84. Test-retest reliability revealed satisfactory reproducibility (ICC=0.83). Construct validity was satisfactory, demonstrating significant correlations between global indicators and the total scale. The P-CPQ score was able to discriminate between different parental/caregiver perceptions of oral conditions in their children (dental caries and malocclusion). The results for the Brazilian version of the P-CPQ confirm that this questionnaire is a reliable and valid instrument to assess parental perceptions on the impact that oral health status has on children's life quality.

Validity of single-item parental ratings of child oral health

OBJECTIVE

The aim of this study was to assess the validity of single-item parental ratings of child oral heath.

METHODS

Data were collected during a study to assess the impacts of dental injury. Clinical examinations of children aged 11-14 years were undertaken that included measures of trauma, decay, treatment needs, and fluorosis. Children with trauma and a group of trauma-free children were followed-up. Parents were mailed a questionnaire along with a questionnaire for the child that contained a short form of the Child Perceptions Questionnaire 11-14 (CPQ11-14). Bivariate analyses examined associations between parents' ratings of their child's oral health, measures of dental disease, clinically defined treatment needs, and scores on the CPQ11-14. Logistic regression was used to see if the associations observed remained after controlling for access to dental care variables.

RESULTS

Complete data were collected from 370 children and their parents. Parental ratings showed significant associations with most of the clinical indicators used and CPQ11-14 scores. Similar results were obtained when the data were analysed for subgroups defined by household income and mother's education. These associations remained after controlling for access to dental services.

CONCLUSION

The data suggest that single-item parental ratings of child oral health have adequate construct validity.

Patient- and population-reported outcomes in public health dentistry: oral health-related quality of life

At present no process is in place in the United States to comprehensively monitor the national burden of oral diseases from the perspective of oral health-related quality of life (OHRQoL), yet available evidence shows that a substantial percentage of the adult population rates their oral health poorly. This article reviews applications of OHRQoL in dental public health. The authors specifically review its use, contributions, and needed advances in: (1) monitoring the impacts of oral diseases on OHRQoL at the national level, and in public health surveillance at the state and local levels; (2) treatment outcomes research and program evaluation; and (3) clinical practice.