Measuring conceptual health knowledge in the context of oral health literacy: preliminary results

Periodontal health literacy in Germany-Results of a telephone survey

OBJECTIVE

Assess the periodontal health literacy of German adolescents, adults and senior residents.

BACKGROUND

The prevalence of periodontitis is high. One explanation for this may be that people lack periodontal health literacy (PHL).

METHODS

This was a cross-sectional descriptive study. Former participants of the 5th German Oral Health Study (n = 333 16-year-olds, n = 307 39-48-year-olds, n = 332 69-78-year-olds) participated in a computer-assisted telephone interview. Open-ended questions (OEQs) were used to assess the participants' current knowledge. Corresponding single- and multiple-choice questions (SCQs and MCQs) supplemented the OEQs to allow detailed analyses of the nature of the knowledge gaps.

RESULTS

Less than 10% of the participants in the three age groups could explain the term 'periodontitis' or select the correct answer in an SCQ. Responding to the OEQs, 89% of 16-year olds, 64% of 39-48-year-olds, and 59% of 69-78-year-olds, could not name any consequence of periodontitis, and 83%, 51%, and 60%, respectively, could not name any risk factors. The OEQs regarding proper oral hygiene behaviour revealed that participants lacked awareness regarding important aspects of oral hygiene (e.g., systematics) or areas to which they should pay attention to (e.g., interdental spaces and gingival margins).

CONCLUSIONS

The survey revealed PHL deficits in German adolescents, adults, and seniors and a need for community-based measures to improve PHL in all age groups. Dental teams should be aware that their patients might lack the PHL necessary for understanding and adherence to professional dental advice, and that they might even lack PHL regarding the proper use of oral hygiene devices.

Test of Oral Health Literacy in Adults (TOHLA): development and psychometric evaluation of a new scale

This study aimed to develop and rigorously evaluate the Test of Oral Health Literacy in Adults (TOHLA) for the Iranian population, addressing the limitations of existing oral health literacy (OHL) measurement instruments and contributing to the literature on OHL assessment. The development of the TOHLA involved a qualitative approach, which included a comprehensive literature review and semi-structured interviews with a panel of 15 experts from diverse fields and 22 Iranian adults aged 18 to 64 years. The instrument was designed with 48 items categorized into four domains: cognitive skill, communication skill, media skill, and functional skill. Content validity was established through expert input and content validation indices. Construct validity was supported by factor analysis, and concurrent validity was assessed by comparing TOHLA scores with demographic variables. Internal consistency and test-retest reliability analyses were performed to assess the instrument's reliability. The psychometric evaluation of the TOHLA demonstrated strong content validity, construct validity, concurrent validity, internal consistency, and test-retest reliability. The instrument exhibited a high level of internal consistency, with a Cronbach's alpha coefficient of 0.81 for the entire scale. Test-retest reliability was satisfactory, with an intraclass correlation coefficient (ICC) of 0.83. Concurrent validity analysis showed statistically significant associations between OHL scores and demographic variables, supporting the instrument's overall performance. The TOHLA overcomes the weaknesses observed in existing instruments and offers a comprehensive tool with strong psychometric properties to assess the OHL of the Iranian adult population. Researchers, policymakers, and healthcare providers can utilize the TOHLA to address oral health challenges and enhance overall oral health outcomes among Iranian adults.

Oral health literacy, knowledge, practice and beliefs among Asian Americans: A scoping review

OBJECTIVES

The Asian American (AsA) population is at high risk for poor oral health outcomes and remains an underserved and understudied community. Low oral health literacy could explain poor oral health behaviours, practices and outcomes in this population. The aims were as follows: (i) provide a scoping review of oral health literacy, knowledge, practice and beliefs among AsA individuals residing in the United States; (ii) identify any instruments or tools translated into participants' language and (iii) determine whether the translated instruments had been assessed for validity and reliability.

METHODS

The current study used a scoping review framework based on PRISMA-ScR that included rigorous eligibility criteria, search strategy, independent selection process with adjudication, and standardized reporting of outcomes. The search was conducted on March 14, 2022, and updated on February 25, 2023 and February 13, 2024, in the following databases: Ovid MEDLINE, Embase, Web of Science and CINAHL. Peer-reviewed original research on oral health literacy, knowledge, awareness, practice, and beliefs related to oral health care in AsA subgroups published in English were included. Two reviewers independently assessed whether titles and abstracts should be included for review, with discrepancies adjudicated by a third reviewer. Data extracted from articles used a standard template that included study design, and measurement tools of oral health, knowledge, awareness, practice and beliefs, as well as results and conclusions of the publication. In addition, the template captured whether the translated and original measurement tools were assessed for reliability and validity.

RESULTS

Of the 367 papers identified, 10 studies that met eligibility criteria were included in the final review. Of these, four studies used previously validated tools to assess oral health measurements in AsA. Only five of the studies translated the tools into the participants' native language. Although AsA exhibited lower oral health literacy than Whites but higher than Hispanics and African Americans, none of the translated tools were assessed for reliability and validity. Acculturation and country of birth were factors influencing oral health behaviours related to good oral health practice and utilization, with AsA born in the United States exhibiting higher oral health utilization than those born in their country of origin. Oral health beliefs played a significant role in dental care utilization among AsA populations.

CONCLUSIONS

The scoping review on oral health in Asian American communities identifies a significant research gap, particularly in the lack of validated tools for assessing oral health literacy, which varies across ethnic groups. It notes that AsA generally have lower oral health literacy compared to Whites, but higher than Hispanics and African Americans. AsA born in the United States shows better oral health practices, influenced by acculturation and birth country. The findings emphasize the need for more thorough and culturally adapted research methods to address oral health disparities in this diverse group.

Evaluating pre-and post-oral health literacy of undergraduate nursing students on an oral-systemic health learning intervention

INTRODUCTION

Oral health is significantly linked with systemic health. Nurses play a crucial role in patient education. Improving oral health literacy in nursing students can pave the way for the seamless integration of oral health into nursing practice.

OBJECTIVE

This study aimed to evaluate an interprofessional co-designed oral-systemic health learning intervention using a pre-and-post study design that measured oral health literacy levels among Year 2 undergraduate nursing students.

METHODS

Evaluation was measured using the validated Comprehensive Measure of Oral Health Knowledge questionnaire before and after the semester-long education intervention. Data were analyzed using independent and paired t-tests and an analysis of variance one-way analysis of variance.

RESULTS

A total of 78 out of 164 students (82% female, 42% aged 21-24, and 52% speaking English as a first language) participated in the pre- and post-study surveys. Statistically significant improvement was noted in pre-and-post total oral health literacy scores (Pre 14.92 [3.85] vs.. Post 15.85 [3.74], p = 0.031). Students showed the highest proficiency in the domain of oral disease prevention, while oral cancer knowledge was the least mastered domain. Those without English as their first language and those with secondary education as the highest qualification showed the greatest improvement in oral health literacy scores post-intervention.

CONCLUSIONS

This study highlights the efficacy of an interprofessional co-designed oral-systemic educational intervention in increasing oral health literacy among undergraduate nursing students. This intervention marks a preliminary step towards integrating oral health into future nursing practice. Further research is warranted to explore the enduring impact of these interventions on their future clinical endeavors.

Baltimore oral epidemiology, disease effects, and HIV evaluation study (BEEHIVE) study protocol: a prospective cohort study

BACKGROUND

As antiretroviral therapy has become widely available and highly effective, HIV has evolved to a manageable, chronic disease. Despite this health advancement, people living with HIV (PLWH) are at an increased risk for age-related non-communicable diseases (NCDs) compared to HIV-uninfected individuals. Similarly, PLWH are at an increased risk for selected oral diseases. PLWH with a history of injecting drugs experience an even greater burden of disease than their counterparts. The overall objective of the Baltimore Oral Epidemiology, Disease Effects, and HIV Evaluation (BEEHIVE) study is to determine the combined effects of HIV infection and NCDs on oral health status. The specific aims of the study are to: (1) determine to what extent HIV status influences access to and utilization of oral health care services; (2) determine to what extent HIV status affects self-reported and clinical oral health status; (3) determine to what extent HIV status influences the progression of periodontitis; and (4) determine to what extent HIV status impacts the periodontitis-associated oral microbiome signature.

METHODS

The BEEHIVE study uses a prospective cohort study design to collect data from participants at baseline and at a 24-month follow-up visit. Data are collected through questionnaire assessments, clinical examinations, and evaluation of oral microbiological samples to determine the drivers of oral disease among a high-risk population of PLWH with a history of injection drug use and prevalent comorbid NCDs. The established AIDS Linked to the Intravenous Experience (ALIVE) cohort serves as the source of participants for the BEEHIVE Study.

DISCUSSION

Upon completion of the BEEHIVE study, the knowledge gained will be important in informing future clinical and preventive interventions that can be implemented into medical and dental practice to ultimately help eliminate long-standing oral health inequities that PLWH experience.

An Epistemic Look at Parental Conceptual Knowledge and Oral Health Outcomes in Children

Objective. This study explores the impact of parental oral health knowledge on children's oral health, investigating if limited knowledge contributes to poor outcomes. The CAMBRA caries risk assessment and the World Health Organization dmft/DMFT index measure oral health. Methods. Over 23 months, the Knowledge Related to Oral Health Literacy (KROHL) questionnaire assesses parental knowledge in 4 domains and 5 oral health conditions. Pearson Correlation Coefficient analyzes the association between KROHL scores and CAMBRA outcomes. Results. Positive correlation emerges between parental oral health knowledge levels and children's dental caries risk, indicating the KROHL questionnaire's utility in identifying knowledge gaps. No standardized method for measuring oral health knowledge exists, although various tools claim to address aspects of the issue. This study pioneers the correlation between oral health knowledge and CAMBRA outcomes. Conclusion. The KROHL questionnaire proves a practical, disease-specific tool for research, emphasizing parental oral health knowledge's pivotal role in children's oral health. It serves as a valuable means to identify knowledge gaps and potential areas for intervention and education in oral health.

Supporting health education policies: translation, cross-cultural adaptation and validation of a health literacy instrument, in French

Background

Oral health is a fundamental human right and is inseparable and indivisible from overall health and well-being. Oral Health Literacy (OHL) has been proved to be fundamental to promoting oral health and reducing oral health inequalities. To our knowledge, no OHL instrument to evaluate OHL level is currently validated in French language despite the fact it is the fifth most widely spoken languages on the planet. The Oral health literacy Instrument (OHLI) appears to be the most interesting OHL instrument to adapt into French because it is already available in English, Spanish, Russian, Malaysian, and it contains both reading comprehension and numeracy sections. Its psychometric properties have been rated as adequate.

Objective

The aim of this study was to translate and adapt cross-culturally the OHLI into French, to evaluate its psychometric properties and to compare its results to oral health knowledge.

Method

This study followed and applied well-established processes of translation, cross-cultural adaptation and validation, based on the recommendations of the World Health Organization guidelines and on the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) study design checklist for patient-reported outcomes. Two psychometric assessments were planned, the comparison of OHLI-F scores according to education level and frequency of dental visits, and the test-retest reliability of the OHLI-F.

Results

A total of 284 participants answered the OHLI-F. The OHLI-F scores were significantly different between participants with different levels of education and frequency of dental visits (p < 0.001). Participants with an education level lower than the baccalaureate, and those who never visit the dentist or only in case of pain, had significantly lower OHLI-F scores. Internal consistency was excellent (Cronbach's alpha = 0.881-0.914). Test-retest reliability was very high (intraclass correlation = 0.985 to 0.996).

Conclusion

The OHLI-F has demonstrated adequate psychometric properties and can therefore be used to measure oral health literacy in French-speaking populations.

Do sociodemographic factors influence the levels of health and oral literacy? A cross-sectional study

BACKGROUND

Oral health literacy has gained importance in dental literature, and its relationship with oral health status and association with health status (HL) has been reported. Then, an association between the levels of HL and OHL could be expected. This study aimed to assess the levels of HL and OHL according to sociodemographic factors and to explore a possible association between HL and OHL.

METHODS

The European Health Literacy Survey and Oral Health Literacy Adults Questionnaire were applied to a convenience sample from Portuguese individuals. Also, sociodemographic factors such as sex, age, schooling level of the participants and their parents, and if the participants were professionals or students of the health field were assessed. To analyze the data, the Kruskal-Wallis and Mann-Whitney U tests were used to compared sociodemographic variables and the levels of literacy in general and oral health. The Spearman correlation test assessed the correlation between the levels of HL and OHL.

RESULTS

HL results showed that 45.1% of the volunteers were considered in a "problematic level" and 10.3% in "excellent level". However, 75% presented an adequate level of OHL. Regarding the levels of HL in each sociodemographic variable, significant higher levels of "excellent level" were found in health professionals and students when compared with participants not related to health area (p < 0.001). Comparisons between the levels of OHL in each sociodemographic variable showed, significant differences regarding sex (p < 0.05), age (p < 0.001), levels of schooling of the participants and their parents (p < 0.009 and p < 0.001) and relationship with health field. (p < 0.001). A significant positive - weak correlation was found between HL and OHL (p < 0.001).

CONCLUSIONS

HL and OHL levels are associated and could be influenced by sociodemographic factors.

[Association of oral health literacy and behaviour with physical oral health. What role can dental education play?]

BACKGROUND

Oral health is an essential component of a person's general health and well-being. It is influenced by many factors. These include individual aspects such as oral health literacy and oral health behaviour. The aim of this study was to investigate the association between oral health literacy and behaviour with physical oral health.

METHODS

In this population-based cross-sectional study, data of 5510 subjects enrolled in the Hamburg City Health Study (HCHS) from 2016 to 2018 with a mean age of 62.1 years and 50.7% women were evaluated. Physical oral health was assessed using the 14-item Physical Oral Health Index (PhOX). A newly developed 10-item questionnaire based on the Oral Health Literacy Adult Questionnaire and the 5th German Oral Health Study were used to determine oral health literacy and behaviour.

RESULTS

The sum score of the 10 questions related to oral health literacy and behaviour significantly correlated with the PhOX sum score (r = 0.23; p < 0.001). An increase of one point in the total score of oral health literacy and behaviour was associated with an increase in the PhOX sum score of 1.45 points on average. This association decreased only marginally after integrating potential confounders such as age and education.

CONCLUSION

Higher oral health literacy and better oral health behaviour are associated with better physical oral health. Oral health literacy and behaviour should be important targets in dental education to efficiently and sustainably improve the oral health of the general population.

Oral health profile and periodontal diseases awareness and knowledge among the jordanian population: a cross-sectional study

OBJECTIVE

To explore the oral health profile and periodontal diseases awareness and knowledge among the Jordanian population. In addition, we aimed to identify predictors of good knowledge of periodontal diseases.

METHOD

This was an online cross-sectional survey study that was conducted in Jordan between January and May 2022. A total of 13 item from the world health organisation (WHO) oral health questionnaire for adults were used to examine the oral health profile of our study participants. In addition, a previously developed questionnaire by Abdulbaqi et al. were adapted and used to examine participants' knowledge about periodontal diseases. Binary logistic regression analysis was used to identify predictors of better knowledge of periodontal diseases.

RESULTS

This study involved 1,099 participants in total. More than half of them (61.1%) claimed that throughout the previous 12 months, they had experienced pain or discomfort in their mouths or teeth. Nearly half of the participants said their teeth and gums were in good or very good condition. 70.7% said they brush their teeth once or more per day. The vast majority of them (93.0%) claimed to brush their teeth using toothpaste that contained 61.9% fluoride. The most frequent cited cause for dental visits was pain or difficulty with teeth, gums, or mouth (36.3%), according to almost one-third of study participants who said they had visited a dentist during the previous six months. The most commonly reported problems that occurs frequently due to the state of the participants' teeth or mouth were avoiding smiling because of teeth, feeling embarrassed due to appearance of teeth, and having difficulty in biting foods with 11.0%, 10.2%, and 9.0%, respectively. Tea with sugar (16.5%) was the most frequently reported beverage as being consumed frequently on a daily basis. The most popular tobacco product to be smoked often on a daily basis was cigarettes (21.6%). For periodontitis knowledge questions, the percentage of accurate responses ranged from 32.3 to 55.8%. The majority of participants (55.8%) were able to recognize that poor oral hygiene is one of the most frequent causes of malodor, whereas the least number of participants (32.3%) were able to recognize that improper teeth brushing is a frequent cause of gingival recession.

CONCLUSION

The average degree of periodontitis knowledge among Jordanians was moderate. Along with it, there were modest oral hygiene practices. In order to prevent further oral complications that have a detrimental influence on patients' quality of life, educational campaigns are required to increase public awareness of knowledge and practices in terms of proper oral hygiene and periodontitis.

Association between oral health knowledge, perceived oral health related quality of life, perceived oral health status and emergency department and/or urgent care visit: Results from the multi-site oral health literacy study

OBJECTIVES

To assess the link between oral health knowledge (OHK), self-perceived oral health, and emergency room (ER)/urgent care utilization for a dental problem.

METHODS

Data were analyzed from a convenience sample of 790 adult participants who presented to two US dental schools and completed an interviewer-administered survey. Key independent variables were OHK assessed with the Comprehensive Measure of Oral Health Knowledge (CMOHK) instrument, self-perceived oral health status and quality of life determined using the General Oral Health Assessment Index (GOHAI) scores. The dependent variable was ER and/or urgent care utilization for a dental problem. Select sociodemographic variables such as age and gender were adjusted for in logistic regression models using SAS.

RESULTS

15.7% of the participants had ever visited an ER and/or urgent care for a dental problem. CMOHK scores were not significantly associated with visits to the ER and/or urgent care. In adjusted analysis, participants with unfavorable GOHAI scores were about three times as likely to have had an ER and/or urgent care visit (OR = 2.60, 95% CI: 1.66-4.09). Similarly, participants who were unsatisfied with their oral health were about twice as likely to have had an ER and/or urgent care visit (OR = 1.91, 95% CI: 1.21-3.00) as compared to those satisfied with their oral health status.

CONCLUSION

Individuals unsatisfied with their oral health and those with unfavorable perceived oral health related quality of life could benefit from a greater awareness of dental service availability and extended hours including weekend hours at public dental clinics.

Defining the Connotations of Oral Health Literacy Using the Conceptual Composition Method

Due to advancements in research, the concept of oral health literacy (OHL) has become rich in connotations, with over 250 definitions present in the literature and government and organizational reports. The diversity of OHL definitions and connotations not only produces conflicting results but also limits the production of accurate OHL measurement and assessment tools while simultaneously hindering the construction of health literacy intervention policies. To clarify the connotations of OHL and establish a scientific basis for evaluation, we conducted a systematic review, searching and analyzing the literature related to the conceptual connotations of OHL. Additionally, we extracted basic, methodological, and OHL conceptual connotation information from the literature. With reference to the review framework, we classified the conceptual connotations of OHL into antecedents of OHL, the core of OHL, mediators, and outcomes of OHL. The comprehensive conceptual connotations of OHL were obtained through a systematic review and concept mapping based on the related literature. Our analysis revealed that the antecedents of OHL can be classified in two categories: personal factors and external factors. The core conceptual connotations of OHL include three core dimensions (with 16 subdimensions): (1) basic skills-literacy, reading comprehension, numeracy, hearing, oral expression, communication, and knowledge; (2) information-related abilities-information acquisition, information understanding, information communication, information evaluation, information utilization, and information decision-making; and (3) oral health maintenance abilities-interpersonal skills, self-regulation, and goal achievement. The mediator of these connotations is oral health behaviors, with oral health being the result of OHL. This study further clarifies the conceptual connotations of OHL, serving as a reference for future OHL-related studies.

Psychometric properties of an oral health literacy scale for people living with diabetes

This study evaluated the construct validity of the instrument Oral Health Literacy among diabetics. A probabilistic random sample of 239 diabetics from an infinite population answered the 10 items of the questionnaire. The structural validity was assessed by confirmatory factor analysis and goodness of fit, chi-square per degrees of freedom ratio (X2/df), comparative fit index (CFI), goodness-of-fit index (GFI), and root-mean-square error of approximation (RMSEA). Internal consistency was estimated by the average variance extracted (AVE) and composite reliability (CR). The scores were dichotomized with the upper limit of the 95% confidence interval as the cutoff point. The three-dimensional model presented good quality parameters (X2 /df = 2.459; CFI = 0.988; TLI = 0.981) and poor RMSEA (0.078). Internal consistency was adequate; AVE for the Access, Understand/appraise, and Apply subscales were 0.831, 0.981, and 0.954 and the CR for these subscales were 0.893, 0.962, and 0.822, respectively. Inadequate literacy ranged from 41.8 to 48.1%. The three-dimensional model identified (access, understand/appraise, and apply) showed structural validity, good internal consistency, and understandability.

Development of KROHL, a tool for evaluating oral health knowledge

Objectives

The authors aim to evaluate a scale assessing oral health knowledge, the KROHL (Knowledge Related to Oral Health Literacy) including the inter-rater reliability for scoring open-ended questions, internal consistency of the hypothesized scales, the discriminant validity of the resulting scale and its relationship to existing measures of oral health literacy.

Methods

The questionnaire was administered via face-to-face interviews to 144 volunteers recruited in the waiting areas of clinics throughout the NYU College of Dentistry.The KROHL questionnaire evaluates oral health knowledge by asking open-ended questions about the appearance, cause, treatment and prevention of caries, gum disease, oral cancer, tooth loss and malocclusion. Those 20 questions were scored to produce scale scores. Demographic information, a self-reported measure of HL and the CMOHK (Comprehensive Measure of Oral Health Knowledge) were also collected.Data were analyzed using Pearson correlation coefficients and principal components analysis, by computing Cronbach's alpha and Cohen's kappa, and by comparing group means with ANOVA.

Results

Kappa indicated good to excellent agreement among raters for the full and the individual subscales of the KROHL. Cronbach's alpha indicated good consistency of the full scale score, but not the individual scales. The mean (SD) KROHL score was lower in the patient group than in the dental students (13.3 (5.9) vs. 26.1 (4.7), p < .001), and varied directly with education level within the patients. KROHL scores were unrelated to existing measures of health literacy.

Conclusions

The KROHL scale is an innovative, reliable and valid tool to assess overall oral health knowledge and provide information to customize educational interventions. Further research is needed to determine the validity and reliability of the scale in multiple settings.

Innovation

The innovation of the KROHL tool of assessment of oral health knowledge lies in its ability to scale depth of knowledge within the domains of identification, causes, prevention, and treatment for the most common oral conditions.

Measuring health literacy: A systematic review and bibliometric analysis of instruments from 1993 to 2021

BACKGROUND

It has been about 30 years since the first health literacy instrument was developed. This study aimed to review all existing instruments to summarize the current knowledge on the development of existing measurement instruments and their possible translation and validation in other languages different from the original languages.

METHODS

The review was conducted using PubMed, Web of Science, Scopus, and Google Scholar on all published papers on health literacy instrument development and psychometric properties in English biomedical journals from 1993 to the end of 2021.

RESULTS

The findings were summarized and synthesized on several headings, including general instruments, condition specific health literacy instruments (disease & content), population- specific instruments, and electronic health. Overall, 4848 citations were retrieved. After removing duplicates (n = 2336) and non-related papers (n = 2175), 361 studies (162 papers introducing an instrument and 199 papers reporting translation and psychometric properties of an original instrument) were selected for the final review. The original instruments included 39 general health literacy instruments, 90 condition specific (disease or content) health literacy instruments, 22 population- specific instruments, and 11 electronic health literacy instruments. Almost all papers reported reliability and validity, and the findings indicated that most existing health literacy instruments benefit from some relatively good psychometric properties.

CONCLUSION

This review highlighted that there were more than enough instruments for measuring health literacy. In addition, we found that a number of instruments did not report psychometric properties sufficiently. However, evidence suggest that well developed instruments and those reported adequate measures of validation could be helpful if appropriately selected based on objectives of a given study. Perhaps an authorized institution such as World Health Organization should take responsibility and provide a clear guideline for measuring health literacy as appropriate.

The Effect of an Educational Intervention on Oral Health Literacy, Knowledge, and Behavior in Iranian Adolescents: A Theory-Based Randomized Controlled Trial

Introduction

Oral health is one of the most important issues in public health. Most educational interventions, as the primary prevention strategy, are focused on increasing information and knowledge and are not usually effective. Therefore, the present study is aimed at determining the effect of theory-based education on oral health behavior and its psychological determinants including dental health literacy.

Method

This randomized controlled educational trial was conducted in two girls' high schools that were selected by multistage cluster sampling and were divided into an intervention and a control group. Literacy, knowledge, oral health behavior, dental plaque index, and constructs of the protection motivation theory were evaluated before and one month after four training sessions. Finally, the data were entered into the SPSS 19 software and were analyzed using the chi-square test, independent t-test, and Mann–Whitney test at the significant level of 0.05.

Result

Before the intervention, there was no significant difference between the intervention and control groups regarding the mean scores of knowledge, behavior, and oral health literacy; plaque index; and protection motivation theory constructs. After the educational intervention, however, the means of these variables were significantly improved in the intervention group compared to the controls (p < 0.05).

Conclusion

The study findings were in favor of the effectiveness of the theory-based educational intervention in improving the knowledge, literacy, and behavior related to oral health. Yet, further research is suggested to determine the effectiveness of such an intervention in male students as well as in populations with different socioeconomic and cultural statuses.

Cross-Cultural Adaptation and Validation of the Oral Health Values Scale for the Portuguese Population

Background: To adapt and validate cross-culturally the Oral Health Values (OHVS) questionnaire to Portuguese language. Methods: The OHVS questionnaire was culturally translated and adapted according to international guidelines. We enrolled 280 patients in a population-based epidemiological survey conducted at the Egas Moniz Dental Clinic (Almada, Portugal). The participants answered the Portuguese version of the OHVS (OHVS-PT), which is a 12-item scale with four-factor structure (Professional Dental Care, Appearance and Health, Flossing and Retaining Natural Teeth factor). Psychometric properties were tested using content validity, construct validity, internal consistency, and test−retest reliability. Results: The OHVS-PT presented adequate reliability (ICC = 0.93, 95% confidence interval (CI): 0.86; 0.97, p < 0.001) with values for the Cronbach’s alpha coefficient of the sub-constructs ranging from 0.92 to 0.98. In the Confirmatory Factor Analysis, the final models presented good fit, with the Comparative Fit Indices ranging from 0.882 to 0.891 and the root-mean-squared error of Approximation between 0.065 and 0.069. Conclusions: The OHVS-PT was shown to be a valid and reliable tool to assess oral health values in a Portuguese population. Further studies should evaluate the psychometric properties of the oral personal representation on dental specialties and its impact on dental appointments and procedures.

Association between the caregivers’ oral health literacy and the oral health of children and youth with special health care needs

Aim

Previous studies have shown that children of caregivers with low oral health literacy (OHL) had more untreated caries than children of caregivers with adequate OHL. However, there is a paucity of information on this relationship among children and youth with special health care needs (CYSHCN). Accordingly, this study aims to assess the association between the caregivers’ OHL and the oral health status of CYSHCN.

Methods

This cross-sectional study was conducted in four schools dedicated for CYSHCN. A 48-item questionnaire gathered information about the demographic and socioeconomic factors, the child/adolescent’s medical condition, dental characteristics, caregiver self-efficacy and the child’s dental attitude. The Comprehensive Measure of Oral Health Knowledge (CMOHK) questionnaire was used to assess the caregivers’ OHL. The Löe & Silness gingival index (GI) and the Silness & Löe plaque index (PI) were used to assess gingival health and plaque levels, respectively. Directed acyclic graphs (DAGs) were utilized for the selection of the appropriate set of confounding variables for regression analysis. The mean score differences and 95% confidence intervals (CI) were estimated to quantify the associations of the various covariates with oral health outcome variables.

Results

This study included 214 child/caregiver dyads. Most participants were physically disabled (56.1%) followed by children with hearing difficulty (9.8%) and congenital anomalies/syndromes (7.9%). The mean PI and GI of the children was 1.26±0.52 and 1.30±0.47, respectively. The median CMOHK score was 12 and the respondents were dichotomized based on the median value. Low caregiver oral health conceptual knowledge was significantly associated with higher PI scores (β [95% CI] = -0.26 [-0.41, -0.13]; p<0.001. Older participants (12-21-year-olds) had significantly higher plaque scores compared with younger participants (6-12-year-olds) (β [95% CI] = 0.33 [0.18, 0.51]; p<0.001). Participants who brushed their teeth twice or more daily had significantly lower (β [95% CI] = -0.15 [-0.43, -0.01]; p = 0.046). Conceptual knowledge score was not significantly associated with GI.

Conclusion

This study found lower caregiver OHL levels to be associated with higher plaque scores for their child.

Cross-cultural adaptation and validation of Malay version of Rapid Estimate of Adult Literacy in Dentistry (MREALD-30) among Orang Asli population in Malaysia

BACKGROUND

The aim of this study was to adapt, translate and validate the Rapid Estimate of Adult Literacy in Dentistry (MREALD-30) instrument for the Orang Asli population in Malaysia.

METHODS

After translation and cross-cultural adaptation, interviews were conducted with 326 participants of the Temuan tribe from village Kampung Tering in Johol, Negeri Sembilan, Malaysia. The instrument's validity was assessed using the scores of MREALD-30, which were compared based on occupation, monthly household income, educational attainment, general literacy, use of dental services, and three dental outcomes. A questionnaire containing socio-behavioral information and validated Malay Oral Health Impact Profile (M-OHIP-14) was also administered. The reliability of the MREALD-30 was assessed by re-administering it to 30 subjects after two weeks. Its correlations evaluated convergent and discriminative validity of MREALD-30 with the level of education and dental visiting habits, monthly household income, respectively. Predictive validity was assessed with M-OHIP-14, while construct validity was evaluated by exploratory factor analysis using the Rasch model.

RESULTS

The internal consistency of the MREALD-30 measured by Cronbach's alpha was 0.89. The test-retest reliability was excellent (ICC 0.95, k = 0.85). MREALD-30 exhibited good construct validity. Rasch analysis showed two factors, and infit mean-square statistics for MREALD-30 were all within the desired range of 0.50-2.0. The discriminant validity and predictive validity were statistically significant (p < 0.05).

CONCLUSIONS

MREALD-30 showed very strong reliability, good construct, discriminant, and predictive validity, but poor convergent validity. Overall, it showed good psychometric properties and can be used in these community settings.

Development and Validation of the Oral Health Values Scale

OBJECTIVES

Oral health values, the degree to which one places importance on or demonstrates investment in improving or maintaining one's dental status, are believed to vary across individuals. Research on this construct is in its infancy, so a new Oral Health Values Scale (OHVS) was developed and validated. The aim was to create a multidimensional measure of oral health values that could be used in future epidemiological or behavioural investigations involving determinants of dental treatment-seeking behaviour and/or oral health.

METHODS

The OHVS was developed in three cross-sectional phases. A 45-item pool was developed, and 12 expert raters from various oral health professions rated the items for their representativeness and relevance, as well as specificity and clarity. Based on the expert feedback, an initial 30-item scale was subsequently established and administered to a developmental sample (N = 306) using Amazon's Mechanical Turk (MTurk). The scale was further refined to be 12 items and its structure was confirmed in a validation sample (N = 308), also using MTurk. Correlations among OHVS scores and other oral health-related constructs were examined in the developmental and validation samples.

RESULTS

Expert review of items for the oral health values construct and the OHVS provided initial evidence of content validity. The final 12-item scale exhibited a four-factor structure with good internal consistency, α = 0.84. The psychometric properties of the final scale were confirmed in a second sample using confirmatory factor analysis, although evidence for the OHVS's four-factor structure was mixed. Overall, OHVS scores were consistently related to other oral health constructs in anticipated ways, providing evidence of construct validity.

CONCLUSIONS

The OHVS demonstrated content validity, internal consistency, and construct validity. Results suggest that the OHVS is a psychometrically sound instrument.

A new comprehensive oral health literacy scale: development and psychometric evaluation

BACKGROUND

It has been widely accepted that oral health status is related to oral health literacy. The need to measure oral health literacy has led to the development of measurement instruments. This study aimed to develop a comprehensive instrument for adults and to examine its reliability and validity in China.

METHODS

A three-step design process was used. First, a literature review and expert panel discussion were used to draw up a 37-item pool covering oral health knowledge, belief, practice, skill, and functional oral health literacy. The Delphi method was used to delete and modify questions in the item pool. The draft instrument was evaluated by nine experts and the consensus among them was calculated using the content validity index. The scale was then used to conduct a psychometric study among 370 participants from community health centers in Beijing. Construct validity, discriminant validity and concurrent validity were examined. The Cronbach's alpha coefficient, and test-retest methods were used to assess reliability.

RESULTS

The final scale included 30 items across four dimensions. The item-level content validity index was 0.90. Exploratory factor analysis extracted four fixed factors, and the result of the Kaiser-Meyer-Olkin and Bartlett's tests was 0.752, with the model explaining 35.21% of the total variance. The four dimensions were associated with oral health knowledge, perceptions of oral health issues, oral health practice and skills, and functional oral health literacy. The mean score of the lowest 27% was significantly lower than the highest 27% (P < 0.01), suggesting adequate discriminant validity. The associations between comprehensive oral health literacy scores and educational level, income and self-reported literacy level were significant (P < 0.001), showing adequate overall concurrent validity. Internal consistency and test-retest reliability were acceptable, with a Cronbach's alpha of 0.72 and a total test-retest reliability coefficient of 0.979.

CONCLUSIONS

Initial testing of the comprehensive oral health literacy instrument suggested that it is a valid and reliable instrument to evaluate individuals' oral health literacy, with four dimensions for evaluating knowledge, belief, skills, and functional oral health literacy.

Development of the Oral Health Literacy Profile (OHLP)-Psychometric properties of the oral health and dental health system knowledge scales

OBJECTIVES

Current oral health literacy (OHL) instruments vary in focus, methodology, administration time and burden. The widely used word recognition tests fail to encompass important OHL domains, while others exceed time frames for use in practical settings, require an interviewer or mainly measure self-assessments. This paper describes the development of the Oral Health Literacy Profile (OHLP), introduces its components and evaluates the psychometric properties of its two core modules, the knowledge tests.

METHODS

A preliminary version of the questionnaire was developed and assessed for content validity, relevance and redundancy by an expert panel. It was tested in a convenience sample (n = 95) leading to the creation of a 28-item questionnaire, which was afterwards tested in a second convenience sample (n = 193). Item difficulty, discrimination, internal reliability and construct validity were assessed for the oral health knowledge (OHK) and dental health system knowledge (DHSK) modules.

RESULTS

The items showed acceptable range of difficulty (ideal: 7 items; easy: 5 items; and difficult: 3 items) and good to very good discriminatory power (the point-biserial index (PBI) > 0.30: all items). Construct validity was considered to be fulfilled when 75% of the hypotheses of expected group differences were met. Satisfactory internal reliability was observed.

CONCLUSION

With all its components, the OHLP is a suitable short instrument to assess the most relevant dimensions of the multifaceted construct of OHL.

PRACTICE IMPLICATION

The OHLP can be widely used in research, especially suitable in practical settings, and thereby identify patients who may benefit from oral health education.

Men and Oral Health: A Review of Sex and Gender Differences

Sex and gender related health disparities in oral health remain an underappreciated and often over looked aspect of well-being. The goal of this narrative review is to identify sex and gender related oral health disparities by summarizing the current literature related to differences in oral health between men and women. The review identified that men are more likely to: ignore their oral health, have poorer oral hygiene habits, and experience higher rates of periodontal disease, oral cancer, and dental trauma. Men also visit dentists less frequently and compared to women seek oral treatment more often for an acute problem and less often for disease prevention. Women exhibit more positive attitudes about dental visits, greater oral health literacy, and demonstrate better oral health behaviors than men. Men disproportionately develop periodontal diseases due to a combination of biological and gender related reasons including immune system factors, hormone differences, poorer oral hygiene behaviors, and greater tobacco use. There is a male to female ratio of 2:1 for oral cancer, largely attributable to more tobacco use, heavier use of alcohol, and longer sun exposure. Minority men experience a disproportionate burden of oral health disparities because of both their gender and race/ethnic identities. In conclusion, this review identifies several differences between men and women related to oral health and highlights the need for further research to better understand these disparities and how to incorporate them into developing prevention, education and treatment strategies to improve oral health in men.

Assessing oral health literacy of university nursing students: A cross-sectional exploratory study

AIM

Research has proven a link between oral health and numerous chronic systemic diseases. To achieve better health outcomes, there is a need to involve interprofessional primary health care providers, such as nurses to raise awareness and promote oral health. Nurses have regular contact with patients which provides a unique opportunity to impart disease-specific information and technical skills for patients to self-manage their oral health conditions. However, the baseline oral health literacy of undergraduate nursing students at the University of Sydney is not known. Before creating a targeted curriculum to improve oral health literacy amongst nursing students, it is essential to assess the baseline oral health knowledge of these students. This study aimed to assess the oral health literacy level among undergraduate nursing students of the University of Sydney, Australia.

DESIGN

An exploratory research approach was used.

METHODS

A cross-sectional survey study was conducted using the validated Comprehensive Measure of Oral Health Knowledge (CMOHK) instrument. A univariate general linear model was used to explore the association of CMOHK total score with demographic and educational variables.

RESULTS

A total number of 197 nursing students participated in the survey, with a mean CMOHK score of 15.48, SD 3.27. 72% were categorized as having good, 16% fair and 12% poor oral health knowledge. The analysis from the six individual knowledge domains of the CMOHK revealed lower percentages of correct responses in the periodontal disease and oral cancer knowledge domains. Students with English as their second language, on average, scored 2 fewer correct responses (p <.001) than students whose first language was English. Low socioeconomic status was not associated with a low level of oral health literacy.

CONCLUSION

The baseline results show a good level of general oral health knowledge as measured by the CMOHK. However, periodontal disease and oral cancer were identified as the particular domains where a knowledge gap exists. These findings may help to map and design an oral health education intervention to improve oral health literacy amongst nursing students. Culturally responsive pedagogy may need to be considered for students with English as their second language. This baseline survey data may potentially facilitate integrating oral health in nursing education and practice.

Oral health knowledge and oral health related quality of life of older adults

OBJECTIVE

To assess the relationship between oral health knowledge and oral health related quality of life among older adults with different ethnicities living in San Bernardino County, California. There is a gap in oral health knowledge (OHK) and how it relates to perceived oral health related quality of life. Thus, there is a need to assess OHK as a component of oral health literacy and identify areas in which knowledge gaps exit to develop educational strategies that address the need of the elderly population.

MATERIALS AND METHODS

The study was a cross-sectional study that included adults 65 years and older using a validated "Comprehensive Measure of Oral Health Knowledge" (CMOHK) and an "Oral Health Profile Index" (OHIP-14). Odds ratios were conducted to determine the factors associated with OHK.

RESULTS

Mean OHK score were 16.8, 14.6, and 8.9 for Caucasian, Asian, and Hispanics, respectively. "Poor" OHK was significantly associated with participants over the age of 75 years (OR = 1.9; 95% CI: 1.15-3.16), high school education or less (OR = 10.8; 95% CI: 5.92-19.84), minority ethnicity (OR = 7.3; 95% CI: 4.27-12.61), income less than $25,000 (OR = 10.7; 95% CI: 5.92-19.26), and reading ability less than "Excellent" (OR = 7.27; 95% CI: 4.35-12.14). Mean OHIP-Severity scores were 7.4, 12.5, and 24.4 for Caucasian, Asian, and Hispanics, respectively. Respondents with Poor OHK were 5.17 times more likely to be identified with high levels of severity (Severity >10).

CONCLUSION

It is imperative to develop communication strategies to inform older adults on oral health knowledge that provide equal opportunities for all ethnicities.

Proposal of Dental Hygiene Diagnosis for Cancer Patients Based on Dental Hygiene Process of Care in Acute Care Hospitals: A Narrative Review

A narrative review was conducted to propose dental hygiene diagnoses for cancer patients based on dental hygiene process of care in acute care hospitals. Six researchers, including three dental hygienists, all with expertise in oral healthcare for patients with cancer, decided the review outline. All researchers reviewed the literature and developed terminology for dental hygiene diagnoses. The team then modified the terminology and discussed its clarity and acceptability to develop an initial list of dental hygiene diagnosis names according to the dental hygiene human needs conceptual model subscales. In wholesome facial image, one new diagnosis was developed. In protection from health risks, 15 new diagnoses were developed. In biologically sound and functional dentition, 10 new diagnoses were developed. In skin and mucous membrane integrity of the head and neck, 10 new diagnoses were developed. In freedom from head and neck pain, two new diagnoses were developed. In freedom from anxiety and stress, eight new diagnoses were developed. In responsibility for oral health, five new diagnoses were developed. In conceptualization and understanding, three new diagnoses were developed. Based on this study, it is necessary for the academic community to develop a better taxonomy of dental hygiene diagnoses pertaining to dental hygienist clinical practice.

Translation, cross-cultural adaptation and psychometric evaluation of Brazilian Portuguese version of the 14-item Health Literacy Scale

We evaluated the psychometric properties of the Health Literacy Scale - 14 (HLS-14), the Brazilian Portuguese version. In the methodological study with a cross-sectional design, the following were performed: translation, cross-cultural adaptation and evaluation of the psychometric properties. After being subjected to a committee of experts, translated and adapted, the instrument was pre-tested with 52 adults and applied to 143 adults and older people of Piracicaba-SP. Internal consistency was assessed based on the Kendall correlation coefficient and Cronbach's alpha (>0.70), and the confirmatory factor analysis (CFA) was conducted using the chi-square test, the Standardized Residual Mean Square Root (SRMR), the Root Mean Square Error of Approximation (RMSEA) (<0.05), the Comparative Fit Index (CFI) (>0.95) and the Tucker-Lewis Index (TLI) (>0.95). The analysis of operational equivalence showed agreement between most of the questions, exception questions 6, 8, 9 and 14. Cronbach's alpha was 0.82. There was reasonable adjustment in the CFA: CFI=0.886, TLI=0.86, RMSEA=0.085 (90%CI: 0.065-0.105), SRMR=0.071, chi-square (74 degrees of freedom) = 149.510, p<0.001. The exclusion of question 5 increased the adjustment level to satisfactory. The Brazilian Portuguese version of HLS-14 can be considered a valid health literacy assessment instrument.

Systematic review of the tools of oral and dental health literacy: assessment of conceptual dimensions and psychometric properties

BACKGROUND

This article aims to provide a description of conceptual dimensions and psychometric properties of the tools of oral and dental health literacy.

METHODS

Two authors in this study conducted electronic searches in the Medline (via PubMed), and Embase databases to find relevant articles from 1990 to present day. Evaluation of the tools was carried out in two parts; general evaluation of the tools using skills introduced by Sørensen et al., and qualitative assessment of psychometric properties using COSMIN checklist.

RESULTS

After reviewing 1839 articles on oral and dental health literacy and evaluating 33 full text articles for eligibility, 21 articles entered the study. The sample size varied from 20 to 1405 subjects and the items of each tool ranged from 11 to 99 items. Of the 21 tools examined, 16 tools were evaluated for word recognition. For the studies examined, the evaluation of COSMIN scores was often fair or good. Of the 21 tools examined, 9 tools at least in one dimension were in the category of "poor", 19 tools were in the category of "fair", 20 tools were in the category of "good", and 4 tools were in the category of "excellent" in at least one dimension.

CONCLUSION

The findings of this study showed that some aspects of oral and dental health literacy are being ignored in the existing tools. Therefore, the authors of present study emphasize on the necessity to design and develop a comprehensive tool and take into account two characteristics of simplicity and briefness for international use.

The oral health and periodontal diseases awareness and knowledge in the Iraqi population: Online-based survey

OBJECTIVES

This study aimed to evaluate oral health (OH) and periodontal diseases (PD) awareness in the Iraqi population.

MATERIAL AND METHODS

This study was a questionnaire-based online survey of two weeks duration. The questionnaire was built using a Google platform and was distributed randomly via social media (Facebook and Telegram). The questionnaire consisted of a demographic data section and two other main sections for the evaluation of OH and PD awareness. Each response was marked with "1" for a positive answer and "0" for the other answers. For each respondent, answers were summed to give an overall score. The frequency of positive responses was used to determine the association of awareness with demographic data and the level of awareness into low, moderate, and high levels.

RESULTS

A total of 1,465 were included in the final analysis after application of exclusion criteria. The respondents showed significantly higher levels of awareness about PD (mean ± SD = 3.66 ± 1.42) than OH awareness (mean ± SD = 2.19 ± 1.29). Analysis of data showed that OH awareness was mainly associated with high degree holders (OR 1.851) and age > 45 years (OR 1.730). However, PD awareness did not show any evident association with demographic variables investigated. In general, the respondents exhibited low levels of OH knowledge and low to moderate level of PD knowledge.

CONCLUSIONS

Despite limitations, this study revealed inappropriate levels of OH and PD awareness and knowledge in the Iraqi population and provided the baseline data necessary for the development of Governmental educational programs and health awareness campaigns which are highly suggested particularly focusing on the primary and high schools, in an attempt to improve the levels of awareness.

Mothers' oral health literacy and children's oral health status in Pikine, Senegal: A pilot study

CONTEXT AND OBJECTIVE

As elsewhere, disadvantaged children in Senegal are those most affected by dental diseases and difficulties in obtaining dental care. Studies conducted mainly in developed countries suggest that a low level of mothers' OHL is correlated with poor oral health of their children. The objective of this study is to estimate the level of mothers' OHL in Senegal and its relationto the dental health of their children.

METHODS

This cross-sectional epidemiological survey took place among 315 children aged from 3 to 9 years old and their mothers. It estimated the children's dental health status by clinical examination which used a disposable examination kit and a headlamp, took place at the child's home, in the mother's presence. Examiners interviewing the mothers administered the Oral Health Literacy-Adult Questionnaire to determine their OHL and questioned them further about their social characteristics and their children's dental health behaviour. Logistic regression and correlations were used for the statistical analysis.

RESULTS

The OHL score ranges from 0 to 17; mothers' mean score was 6.5 (±3.1) and 56.5% had a low score (below the median). The prevalence of dental caries in children was 64.8%. Mothers' high OHL is associated with children caries free and low prevalence of dental caries. The logistic regression showed a significantly protective relation between children's dental caries and mothers' high OHL scores (mean score 12-17) (OR = 0.51, 95% CI: 0.29-0.88), high educational level (OR = 0.42, 95% CI: 0.23-0.76) and a high level of social contact (OR = 0.31, 95% CI: 0.15-0.63). The structural analysis showed that OHL was significantly correlated with both the mothers' social position (r = 0.61 and P<0.001) and the children's caries (r = -0.26 and P<0.001).

CONCLUSION

The OHL level of Senegalese mothers was significantly associated with their children's dental caries. Improving mothers' OHL might therefore help strengthen their capacities to promote oral health, thus helping to improve their children's dental health and reduce inequalities.

Protocol of the TOHLA instrument: A Test of Oral Health Literacy in Adults

BACKGROUND

A proper measurement instrument is selected based on the suggested use of the instrument, the target concept of measurement, and features of measurement (e.g. internal consistency, reproducibility, content and construct validity, responsiveness, and interpretability). Concerning the design and features of measurement, there are not any adequately specific standards for instrumentation to measure oral health literacy (OHL). The present study proposes a protocol that attempts to fill this gap by introducing the psychometrics of a standard questionnaire which measures OHL.

MATERIALS AND METHODS

The present research employs a methodological design and is carried out in Tehran, with data collected through interviews that are held face to face. The data collection procedure involves a review of the related literature, cognitive interviews, fuzzy Delphi Method, and focal groups with participants with OHL work experience for item generation. The target participants of this research are the Iranian adult population and experts working professionally in different health domains. For qualitative data analysis, the content analysis strategy and in the instrument Psychometrics COSMIN checklist will use.

CONCLUSIONS

Achievement of the present research will be used to evaluate the capability of the Iranian adult population in searching, processing, and deciding on healthcare services. This instrument will focus on evaluating both clinical and nonclinical settings. The present research can vastly improve our knowledge of the state of OHL in the Iranian adult population.

Oral health knowledge in relation to educational level in an adult population in Spain

Background

To analyze the relationship between oral health knowledge and educational level among an adult population in Spain, and between oral health knowledge and subjects’ oral hygiene practices, dietary habits, toxic habits, and oral quality of life.

Material and Methods

This transversal study used the Comprehensive Measure of Oral Health Knowledge (CMOHK) questionnaire to evaluate subjects’ knowledge and understanding of oral health, and the World Health Organization oral health questionnaire for adults to evaluate dietary, oral hygiene, toxic habits, and oral quality of life. Participants (n=400) gave their informed consent and data release permission before taking part in the study, which was approved by the University of Valencia Ethics Committee (certificate No.: H145160675341). Statistical analysis was performed using SPSS v22.0 software, applying Student’s t-test, ANOVA, and chi2 test, with significance set at p<0.05.

Results

Oral health knowledge results were: low 41.5% and high 58.5%. An association was found between educational level and oral health knowledge (Chi2: p=0.000). Oral hygiene habits presenting an association with higher levels of oral health knowledge were dental floss use, a higher number of teeth present, and lower prevalence of partial prostheses. A significant association was found between oral quality of life and oral health knowledge.

Conclusions

Oral health knowledge is associated with the individual subject’s educational level. But oral health knowledge is not necessarily reflected in the practice of healthy habits.

Key words:Oral health literacy, oral health habits, oral health knowledge, CMOHK.

Adolescents with worse levels of oral health literacy have more cavitated carious lesions

The aim of the present study was to investigate whether the ability to recognize and read oral health terms is associated with the number of teeth with cavitated carious lesions in adolescents. A population-based cross-sectional study was conducted involving a sample of 746 adolescents representative of students aged 15 to 19 years at the public and private school systems in a city in northeast Brazil. Two examiners who had undergone a training and calibration exercise (inter-examiner and intra-examiner Kappa coefficient: 0.87 to 0.93) performed the diagnosis of caries using the Nyvad Index and evaluated the level of OHL (BREALD-30) of the adolescents. The participants answered questions regarding their history of visits to the dentist and the parents/caregivers answered a questionnaire addressing socioeconomic characteristics. A directed acyclic graph was created to direct the selection of covariables for adjustments in the Poisson multiple regression analysis to test the association between dental caries and OHL (α = 5%). Cavitated carious lesions (codes 3 to 6 on the Nyvad index) were found in 41.6% of the adolescents. Only 29.4% had a high level of OHL (BREALD-30 scores between 23 and 30); 42.3% of the families belonged to the A-B social class and 93% of the adolescents had been to the dentist at least once in their lifetimes. In the multivariate analysis, adolescents with inadequate (PR: 1.69; 95% CI: 1.18–2.41; p = 0.004) and marginal (PR; 1.42; 95% CI: 1.01–1.99; p = 0.042) OHL and those in the lower social classes (C-D-E) (PR: 1.85; 95% CI: 1.39–2.47; p<0.001) had more teeth with cavitated carious lesions. In conclusion, adolescents aged 15 to 19 years with poorer levels of OHL had a larger number of teeth with cavitated carious lesions, independently of their socioeconomic status and history of visiting a dentist.

Development and validation of the Dental Nutrition Knowledge Competency Scale for low-income women

OBJECTIVE

To develop and validate a Dental Nutrition Knowledge Competency Scale to assess dental health-related nutrition knowledge of low-income women.

DESIGN

This is a cross-sectional study. A literature search for foods/dietary practices related to dental caries was conducted and the items were incorporated into an initial questionnaire. A panel of ten nutrition experts evaluated it for its content, readability and relevance, and a focus group of six low-income women determined its readability and comprehension. Then the questionnaire was administered to 150 low-income women. Construct validity was evaluated by item difficulty, item discrimination and factor analysis. Internal consistency reliability was tested via Cronbach's α. In a sub-sample of forty women, test-retest reliability was established. Paired-sample t tests were conducted to examine differences between test scores at the two time points, 2 weeks apart.

SETTINGS

Community centres in low-income housing in Central Texas, USA.

PARTICIPANTS

A total of 150 low-income women, aged 18-50 years; annual household income <250 % of the federal poverty level.

RESULTS

Item difficulty and discrimination analysis resulted in elimination of eight questions. Factor analysis identified twenty-four items that loaded on three factors related to knowledge. These included foods/dietary practices that affect dental caries, added sugars in foods and on food labels, and recommended frequency of oral hygiene practices. The subscales and the completed scale exhibited good internal consistency (mean 0·7 (sd 0·97)) and test-retest reliability (mean 0·8 (sd 0·013)).

CONCLUSIONS

The Dental Nutrition Knowledge Competency Scale is a validated and reliable instrument to assess nutrition knowledge related to dental health in low-income women.

Diabetic patients' knowledge of the bidirectional link: are dental health care professionals effectively conveying the message?

Diabetes mellitus (DM) has emerged as a global public health concern with significant upshots due to its high prevalence, severity and associated complications. The present review aims to evaluate the literature that has investigated the awareness and attitude of diabetic patients about their oral/periodontal health to identify gaps in the dissemination of this critical information. Literature addressing diabetic patient's awareness/knowledge, response to their periodontal health needs, and the source of oral health education was investigated using a computer search of electronic databases. Twenty-six papers were included in the systematic review for analysis. The studies reported data from 13 different countries involving 10 550 participants, 9843 patients with DM and 974 healthy controls. The overall analysis of the studies showed that approximately 73% of the diabetic patients were unaware of the link between their systemic condition (DM) and periodontal health. The results of the study show that a large number of diabetic patients are unaware of the link between oral/periodontal health and DM. There is a strong need to implement the recent guidelines established by the IDF/EFP concerning mutual care of diabetic patients by the medical and dental health care professionals. This will result in improved general and oral health of our diabetic patients.

Association of oral health behavior and the use of dental services with oral health literacy among adults in Tehran, Iran

Objective:

To assess the association of oral health behavior (OHB) and the use of dental services with oral health literacy (OHL) among Iranian adults.

Methods:

This was a cross-sectional population study of a random sample of 1031 adults aged 18–65 in Tehran, Iran. We collected data on tooth brushing frequency, the consumption of sugary snacks and beverages, and time since last dental visit. To measure OHL, we used a validated OHL adults’ questionnaire (OHL-AQ). In addition to descriptive analysis, we used multiple logistic regression models to assess the association of OHB and the most recent dental visit with OHL while controlling for socioeconomic and demographic factors.

Results:

The participants’ mean age was 36.3 (standard deviation 12.9), and 51% were women. Of the participants, 81.3% reported brushing their teeth daily (≥1/day), 37.6% consumed sugary snacks or beverages between meals less than once daily (<1/day), and 36.8% used dental services within the past 6 months. In the adjusted models, high OHL scores significantly correlated with daily (≥1/day) tooth brushing (odds ratio [OR] = 1.97, 95% confidence interval [CI]: 1.30–2.98), the consumption of sugary snacks or beverages (<1/day between meals) (OR = 1.56, 95% CI: 1.13–2.15) and the recent use of dental services (≤6 months) (OR = 1.59, 95% CI: 1.15–2.21), respectively.

Conclusions:

OHL relates significantly to improved OHB and the use of dental services. Oral health promotion programs should, therefore, take into account improvements in adults’ OHL, particularly in countries with developing health-care services.

Conceptual knowledge of oral health among school teachers in South India, India

Objective:

To measure conceptual oral health knowledge among school teachers using comprehensive measure of oral health knowledge (CMOHK) instrument.

Materials and Methods:

A total of 240 school teachers drawn through cluster random sampling from across Sullia taluk. Conceptual knowledge was assessed using Comprehensive measure of oral health knowledge questionnaire. Oral health status was recorded on a World Health Organization oral health assessment Proforma.

Results:

Overall distribution of CMOHK scores revealed that 106(44%) subjects had good conceptual oral health knowledge, 81(33.7%) subjects had fair and 53(22%) subjects were categorized under poor conceptual knowledge respectively. Statistically significant difference was observed for mean scores for conceptual knowledge in relation to gender (12.8v/s 15.3), in terms of type of school teachers (14.4 v/s 11.2) and in relation to age of the subjects. Primary school teachers exhibited a consistently better CMOHK scores 0.003(0.001-0.011) compared to their high school counterparts 0.003(0.001-0.012).

Conclusion:

The mean CMOHK score of this group was 12.5±1.3 and is considered to be fair. There is an inverse association between age, educational levels and income in relation to CMOHK scores.

Psychometric properties of BREALD-30 for assessing adolescents' oral health literacy

OBJECTIVE

To evaluate the psychometric properties of the Brazilian Portuguese version of the Rapid Estimate of Adult Literacy in Dentistry (BREALD-30) administered to adolescents.

METHODS

The study included 750 adolescents: 375 aged 12 years and 375 aged 15–19 years, attending public and private schools in Campina Grande, state of Paraíba, Brazil, in 2017. Reliability was measured based on internal consistency and test-retest reliability. Convergent validity was measured based on correlations between BREALD-30 and Functional Literacy Indicator scores. Divergent validity was measured by comparing BREALD-30 scores with sociodemographic variables. For predictive validity, the association between BREALD-30 scores and the presence of cavitated carious lesions was tested using a multiple logistic regression model. All statistical tests were performed with a significance level of 5%.

RESULTS

BREALD-30 showed good internal consistency for the 12 year olds and 15 to19 year olds (Cronbach’s alpha = 0.871 and 0.834, respectively) and good test-retest reliability [intraclass correlation coefficient (ICC) = 0.898 and 0.974; kappa = 0.804 and 0.808, respectively]. Moreover, item-total correlation was satisfactory for all items. BREALD-30 had convergent validity with the Functional Literacy Indicator for 12 year olds (rs = 0.558, p < 0.001) and for 15 to 19 year olds (rs = 0.652, p < 0.001). Participants with higher oral health literacy levels who attended private schools (p < 0.001), belonged to economic classes A and B2 (p < 0.001), and who had parents with higher education levels (p < 0.001) were included, indicating the divergent validity of the BREALD-30. Participants with lower BREALD-30 scores were more likely to have cavitated carious lesions [12 year olds: odds ratio (OR) = 2.37; 95% confidence interval (95%CI): 1.48–3.80; 15 to 19 year olds: OR = 1.96; 95%CI 1.24–3.11].

CONCLUSIONS

BREALD-30 shows satisfactory psychometric properties for use on Brazilian adolescents and can be applied as a fast, simple, and reliable measure of oral health literacy.

Knowledge, attitudes and behaviours of patients regarding interdental deplaquing devices: A mixed-methods study

OBJECTIVES

This mixed-methods study assessed patients' oral health literacy, motivation level and barriers regarding interdental plaque control.

METHODS

Participants (n = 49) from a study comparing the use of Glide® Pro-Health Floss Original (F) or GUM® Curved Soft-Picks® Advance (SP) completed daily diaries and questionnaires regarding motivation, tiredness, confidence and satisfaction for their deplaquing method. The Mantel-Haenszel chi-square test was utilized. Data were also collected from 19 participants who attended focus group discussions regarding their oral health habits, knowledge, motivators and barriers with interdental plaque control. Discussions were digitally recorded, transcribed and imported into ATLAS.ti 7.5.15 to identify themes.

RESULTS

There were no statistically significant differences between the two groups in relation to age, sex or ethnicity. F users reported statistically significant higher agreement about ability to remove food/debris (P = 0.01), cleaning thoroughly (P = 0.02) and clean feeling of the mouth (P = 0.01). SP users reported higher ease/efficiency of use (P = 0.01), convenience (P = 0.003), easy to hold (P = 0.0001) and easy use away from home (P = 0.008). Daily diaries revealed higher motivation and compliance/ease of use (SP). During the focus groups, some reported that they did not feel clean unless they deplaqued interdentally; however, most reported that they lacked motivation due to constraints on time, no desire due to lack of immediate or tangible rewards, and lack of knowledge on proper use of interdental devices or the benefits of using them.

CONCLUSION

This study showed that the lack of compliance may be due to poor literacy and lack of motivation in patients due to gaps in patient education.

Oral Health Knowledge and Behavior among Adults in the United Arab Emirates

Background

The prevalence of periodontal diseases is increasing in the United Arab Emirates (UAE) despite a worldwide decline in the prevalence of dental caries among children and adolescents. The aims of this study were to determine the levels of oral health knowledge and health-related behavior in adult UAE residents, and the relationship between these variables and oral health.

Methods

A descriptive cross-sectional survey with nonprobability sampling was used in this study. A sample of 630 adults residing in the UAE completed an oral health survey to assess their oral health knowledge and behavior. Mean oral health knowledge and behavior scores were calculated and correlated with population demographic and behavioral variables.

Results

Participants were found to have an acceptable oral health knowledge score (OHKS) of 10.50 (2.36) where 62 % of participants answered the questions correctly. Results showed that age, gender, nationality, smoking, and physical activity were significantly associated with the knowledge score. However, only gender, nationality, and smoking predicted oral health knowledge scores after further regression analysis. On the other hand, the mean oral health behavior score (OHBS) for all participants was 8.91 (2.29); 98% of all participants practiced at least an acceptable level of oral behavior and 53% practiced a good to perfect level. Age, gender, educational level, employment status, insurance status, marital status, nationality, smoking, and physical activity showed significant statistical association with the score of behaviors related to oral health. Only gender, number of diabetes sessions attended, and health information sources used remained significant after further regression analysis.

Conclusion

Further efforts are required to spread awareness about oral health and encourage the UAE population to develop healthy oral habits. Such programs will decrease the occurrence and burden of many chronic oral diseases especially periodontal diseases.

Relationship between oral health literacy and oral health status

Background

Health literacy has been found to be a strong predictor of an individuals’ health, health behavior and health outcomes. Lower literacy has been linked to problems with the use of preventive services, delayed diagnoses of medical conditions, poor adherence to medical instructions, poor self-management skills, increased mortality risks, poor health outcomes, and higher health care costs. The aim of this study is to determine the relationship between oral health literacy (OHL) and oral health status among patients attending a University-affiliated dental clinic.

Methods

A convenience sample of participants was drawn from the dental patients presenting at School of Dental Medicine (SODM), Case Western Reserve University (CWRU). Information about the subjects’ demographic details, income, family size, insurance type and smoking history were collected using a data collection form. Data about the patients’ periodontal and caries risk assessment, caries experience and periodontal status was extracted from the patients’ electronic dental records. The Comprehensive Measure of Oral Health Knowledge (CMOHK) was used to record the oral health literacy. The median CMOHK score was 18, and this was used to categorize the sample into limited OHL (≤18) and adequate OHL (> 18) groups. A multivariate logistic regression model was built to examine the associations between the various independent variables and OHL levels.

Results

Data of 150 respondents were analyzed. More than half of the participants were female (55.3%) and the majority were Caucasian (60%). The average age of participants was 53.3 years [standard deviation (SD) 16.8]. Higher percentage of African Americans and individuals with low education had limited OHL levels (p < 0.05). The mean decayed, missing, and filled teeth (DMFT) score for this population was 7.33 ± 2.68. Subjects with limited OHL had significantly higher mean values for missing teeth (p < 0.05) and lower mean values for filled teeth (p < 0.05) as compared with subjects with adequate OHL Significantly, higher percentage of subjects with limited OHL had severe periodontitis as compared with those with adequate OHL (p = 0.04). Multivariate analysis found that the periodontal status was significantly associated with the OHL scores (p = 0.015).

Conclusion

Subjects with limited OHL levels had poorer periodontal health. Improving the OHL of patients may help in the efforts to improve the adherence to medical instructions, self-management skills and the overall treatment outcomes. Future research could focus on assessing the impact of OHL interventions on the oral health, which could be valuable for clinical practitioners.

Oral health knowledge levels of Hispanics in Iowa

BACKGROUND

Hispanics disproportionately experience preventable oral health conditions in the United States. This study aimed to determine the oral health knowledge (OHK) of Hispanic adults in Iowa to identify potential gaps in knowledge.

METHODS

This cross-sectional study included a convenience sample of self-identifying Hispanic adults. Data pertaining to oral health literacy and demographic, cultural, and dental characteristics were collected. OHK was assessed with the Conceptual Measure of Oral Health Knowledge, and it was categorized as low or high. Bivariate analyses and multiple logistic regression models were conducted to identify the variables related to OHK (P < .05). Institutional review board approval was obtained.

RESULTS

Three hundred thirty-eight participants completed the questionnaire, 68% of participants completed the questionnaire in Spanish, and 51% of all participants had low OHK. Participants were less likely to correctly answer questions pertaining to children's oral health, periodontal disease, and oral cancer. Low OHK was associated with having less than 12th grade education, lack of dental insurance, and preference for a Spanish-speaking oral health care provider.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

OHK appears to be low in this population. Increasing OHK may help decrease oral health disparities and improve oral health outcomes. Furthermore, it is important that oral health care providers have an understanding of barriers that can impede patients' understanding of the health care system. Specifically, minority populations, such as Hispanics, may have a harder time because of certain cultural differences that exist among this ethnic group.

Lower Oral Health Literacy may Lead to Poorer Oral Health Outcomes

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Oral health literacy and associated oral conditions: A systematic review. Firmino RT, Ferreira FM, Palva SM, Granvlle-Garcia AF, Fraiz FC, Martins CC. JADA 2017; 148(8):604-13.

SOURCE OF FUNDING

Government and foundation. This study was supported by the Brazilian Ministry of Education Coordination for the Improvement of Higher Education Personnel, the Minas Gerais State Research Foundation, and the Brazilian National Council for Scientific and Technological Development.

TYPE OF STUDY/DESIGN

Systematic review.

Association of Oral Health Literacy and Dental Visitation in an Inner-City Emergency Department Population

To examine the association between oral health literacy (OHL) with sociodemographic variables and dental visitation in adults presenting to an urban emergency department (ED). Methods: This was a cross-sectional study of a convenience sample of 556 adults aged 18⁻90. Interview data from the study were used to collect self-reported sociodemographic characteristics and dental visitation history. The OHL of the study participants was measured using the Health Literacy in Dentistry scale (HeLD-14), and the score was dichotomized into low and high OHL. Bivariate associations between sociodemographic variables and OHL were conducted using chi-square tests, and logistic regression was used to examine the association between OHL and dental visitation within the past year. Results: Sixty percent of participants reported having visited a dentist within the past year. Over two-thirds of the sample was classified as having low OHL. Low OHL was more common in non-White races, less-educated, single, unemployed, and lower-income individuals, and those without a primary care physician or dental insurance (p < 0.05). Patients with low oral health literacy were 39% less likely to have visited the dentist in the past year (OR = 0.61; 95% CI 0.38, 0.96). Conclusions: This study highlights significant disparities in OHL. Interventions targeted toward the unique needs of underserved populations should be developed to improve health outcomes.

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

BACKGROUND

The scientific evidence regarding the association between parental oral health literacy (OHL) and children's oral health is unclear.

AIM

To evaluate the scientific evidence concerning the association between parental OHL and children's oral health outcomes.

DESIGN

Eight databases were searched. Studies that evaluated oral health outcomes among children and measured parental OHL through a validated tool were included. Two independent reviewers selected studies, extracted data and analysed the risk of bias.

RESULTS

Eleven studies were included. Most (n = 6) had a high risk of bias. Most studies evaluating dental caries found association between lower parental OHL and higher prevalence/experience of dental caries. Poor oral health-related quality of life was associated with decreased parental OHL (P < 0.05). Studies diverged on the association between OHL and the number of filled, extracted teeth, and dental visits. There was no association between children's tooth brushing frequency, use of toothpaste, oral health claim, oral health expenditures and parental OHL. The literature was inconclusive regarding the association between night bottle feeding, negative parental perception of the child's oral health and OHL.

CONCLUSION

Low parental OHL was associated with dental caries among their children. It is too soon to assume an association between OHL and the remaining outcomes.

Limitations of the S-TOFHLA in measuring poor numeracy: a cross-sectional study

Background

Although the Short Test of Functional Health Literacy in Adults (S-TOFHLA) is widely used, misidentification of individuals with low health literacy (HL) in specific HL dimensions, like numeracy, is a concern. We examined the degree to which individuals scored as “adequate” HL on the S-TOFHLA would be considered as having low HL by two additional numerical measures.

Methods

English-speaking adults aged 45–75 years were recruited from a large, urban academic medical center and a community foodbank in the United States. Participants completed the S-TOFHLA, the Subjective Numeracy Scale (SNS), and the Graphical Literacy Measure (GL), an objective measure of a person’s ability to interpret numeric information presented graphically. Established cut-points or a median split classified participants and having high and low numeracy.

Results

Participants (n = 187), on average were: aged 58 years; 63% female; 70% Black/African American; and 45% had a high school degree or less. Of those who scored “adequate” on the S-TOFHLA, 50% scored low on the SNS and 40% scored low on GL. Correlation between the S-TOFHLA and the SNS Total was moderate (r = 0.22, n = 186, p = 0.01), while correlation between the S-TOFHLA and the GL Total was large (r = 0.53, n = 187, p ≤ 0.01).

Conclusions

Findings suggest that the S-TOFHLA may not capture an individuals’ HL in the dimension of numeracy. Efforts are needed to develop more encompassing and practical strategies for identifying those with low HL for use in research and clinical practice.

Trial registration

NCT02151032 (retrospectively registered: May 30, 2014).

Poor Oral Health Literacy May Lead to Missed Dental Appointments

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

The association between oral health literacy and missed dental appointments. Baskaradoss JK. JADA 2016;147(11):867-74.

SOURCE OF FUNDING

Information not available TYPE OF STUDY/DESIGN: Unmatched case-control study that used a convenience nonprobability sampling method.

Oral health literacy and oral health outcomes in an adult population in Brazil

Background

To investigate the association between critical and communicative oral health literacy (OHL) and oral health outcomes (status, oral health-related quality of life and practices) in adults.

Methods

This cross-sectional study examined a household probability sample of 248 adults, representing 149,635 residents (20–64 years old) in Piracicaba-SP, Brazil. Clinical oral health and socioeconomic and demographic data, as well as data on oral health-related quality of life (OHIP-14) and health practices were collected. The oral examinations were carried out in the participants’ homes, using the World Health Organization criteria for oral diseases. The critical and communicative OHL instrument was the primary independent variable, and it was measured using five Likert items that were dichotomized as ‘high’ (‘agree’ and ‘strongly agree’ responses for the 5 items) and ‘low’ OHL. Binary and multinomial logistic regressions were performed on each outcome (oral health status and practices), controlling for age, sex and socioeconomic status (SES).

Results

Approximately 71.5% presented low OHL. When adjusted for age and sex (first model) low OHL was associated with untreated caries (Odds Ratio = 1.92, 95% Confidence Interval = 1.07–3.45), tooth brushing <3 times a day (OR = 2.00, 1.11–3.62) and irregular tooth flossing (OR = 2.17, 1.24–3.80). After SES inclusion in the first model, significant associations were found for low OHL when the outcomes were: presence of biofilm (OR = 1.83, 1.08–3.33), dental care for emergency only (OR = 2.24, 1.24–4.04) and prevalence of oral health impact on quality of life (OR = 2.06, 1.15–3.69).

Conclusion

Adjusting for age, sex and SES, OHL is related to a risk factor (biofilm) and a consequence of poor oral health (emergency dental visits) and can interfere with the impact of oral diseases on quality of life. As low OHL can be modified, the results support oral health promotion strategies directed at improving critical and communicative oral health literacy in adult populations.

Income-Related Inequalities in Access to Dental Care Services in Japan

Background: This study aimed to evaluate whether income-related inequalities in access to dental care services exist in Japan. Methods: The subjects included beneficiaries of the National Health Insurance (NHI) in Chiba City, Japan, who had been enrolled from 1 April 2014 to 31 March 2015. The presence or absence of dental visits and number of days spent on dental care services during the year were calculated using insurance claims submitted. Equivalent household income was calculated using individual income data from 1 January to 31 December 2013, declared for taxation. Results: Of the 216,211 enrolled subjects, 50.3% had dental care during the year. Among those with dental visits, the average number of days (standard deviation) spent on dental care services per year was 7.7 (7.1). Low income was associated with a decreased rate of dental care utilization regardless of age and sex. However, there was a significant inverse linear association between the number of days spent on dental care services and income levels for both sexes. Conclusions: There were income-related inequalities in access to dental care services, regardless of the age group or sex, within the Japanese universal health insurance system.

The value of a combined word recognition and knowledge measure to understand characteristics of our patients' oral health literacy

OBJECTIVE

The objective of the analysis was to examine the association between sociodemographic and dental understanding and utilization characteristics and lower oral health literacy (HL) and knowledge.

METHODS

The cross-sectional Multicenter Oral Health Literacy Research Study (MOHLRS) recruited and interviewed 923 English-speaking, initial care-seeking adults. The questionnaire included participant sociodemographic characteristics, measures of the participant's understanding and utilization of dentistry, and two oral HL measures, the Rapid Estimate of Adult Literacy in Medicine and Dentistry (REALM-D) and the Comprehensive Measure of Oral Health Knowledge (CMOHK), which were combined into a new composite HL and knowledge measure, the MOHLR-K.

RESULTS

In adjusted multivariable analysis, persons who reported more understanding of dentist instructions had higher mean scores for all HL measures. Subjects reporting the highest level of understanding had greater scores by an average of 1.6 points for the MOHLR-K (95% CI: 0.85-2.40, P<.01), 2.11 points for REALMD-20 (95% CI: 0.75-3.48, P<.01) and 2.20 points for CMOHK (95% CI: 1.01-3.40, P<.01) after controlling for demographic and other dental understanding and utilization factors. Persons who reported history of tooth decay had higher MOHLR-K scores by an average of about 0.77 points (95% CI: 0.49-1.04, P<.01), higher REALMD-20 scores by 0.54 points (95% CI: 0.12-0.95, P=.01) and higher CMOHK scores by 1.22 points (95% CI: 0.82-1.63, P<.01) as compared to persons without tooth decay history after controlling for the other factors. Persons who had support all of the time for travel to the dentist had higher scores by an average of about 0.5 points for the MOHLR-K (95% CI: 0.04-0.96, P=.03) and about 0.89 points for the REALMD-20 (95% CI: 0-1.79, P=.05) as compared to subjects with no support after controlling for other factors. Report of periodontal history, financial challenges to delay a dental visit and dental utilization were not significantly associated with any of the HL measures once the other factors were adjusted for in the model.

CONCLUSION

The analysis confirmed that pronunciation of medical and dental terms may not fully reflect comprehension and revealed that understanding both patients' sociodemographic and dental understanding and utilization factors, such as transportation to the dental office associated with lower oral HL and knowledge, could help the profession develop appropriate clear language programmes to improve access to dental care for vulnerable populations.