A school-based public health model to reduce oral health disparities

Health policy and regulations in Seychelles - barriers and opportunities for oral health inclusion

BACKGROUND

Successful and inclusive policies that embrace oral health as part of the health agenda have the potential to alleviate the burden of oral diseases and to promote dental public health. This study aimed to understand the factors influencing the inclusion of oral health in health and public policy and regulations in the Seychelles. The barriers and opportunities for inclusion / non-inclusion as well as the impact thereof were explored.

METHODOLOGY

A qualitative approach was adopted using document analysis and interviews as data collection strategies to allow for a complete analysis of the research problem. Using a purposive sampling approach, individual face to face interviews were conducted with patients, dental staff and representatives of the upper management. Policy and related oral health statistical documents were reviewed to ascertain how oral health was located and implemented from a national to a district level. Thematic analysis and content analysis were used to analyse and interpret the qualitative data.

RESULTS

The study provided insight on how oral health is contextualised in the Seychelles and how public policy and strategic documents influences the oral health outcomes. There is fragmentation in how the health and oral health agendas are managed and it is coupled with a severe lack of involvement and commitment to address the latter.

CONCLUSION

Oral health needs to be integrated in all relevant policies and public health programmes as part of the broader national NCDs in Seychelles in order reduce the incidence of oral diseases in the population.

Science-Informed Health Policies for Oral and Systemic Health

Oral, dental and craniofacial (ODC) health has a profound impact on general health and welfare throughout life, yet US dentists and physicians operate across misaligned silos. This protracted division limits access to optimal health, supports fee for services, and exacerbates health disparities. Early in the 20th century, the most frequent dental therapy was tooth extraction: removed infected teeth were substituted by prosthetic appliances - commonly, dentures or nothing. Most adults assumed becoming edentulous was a normal corollary of aging. With the discovery of penicillin and other antibiotics, healthcare professionals and policy makers predicted infectious diseases would become irrelevant. However, given numerous health threats, including SARS-CoV-2, HIV, multidrug-resistant bacteria, Zika virus, Ebola virus, and now monkeypox, public and professional awareness of transmissible infectious diseases has never been more evident. Ironically, little attention has been paid to unmet transmissible, infectious, common oral diseases - dental caries and periodontal diseases. Therefore, these persist within "the silent and invisible epidemic". The preventable death of a young boy in 2007 from an infected untreated tooth that produced bacterial meningitis is a profound reminder that our nation has vast inequities in education, health, and welfare. The impact of oral infections on hospital-acquired pneumonia, post-operative infection in cardiac valve surgery, and even academic performances of disadvantaged children displayed through sociodemographic characteristics and access to care determinants also are profound! This paper asserts that current and emerging ODC health knowledge and science will inform health policies and advance equity in access to care, affordable costs, and optimal healthcare outcomes. We recommend that legal and regulatory systems and public health programs be required to ensure health equity. A fair healthcare system that addresses holistic healthcare must be transparent, accessible, integrated and provide a standard of oral healthcare based upon scientific evidence for all people across the lifespan.

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Trends in Access to Oral Health Care among Adults from the N-E Region of Romania

Aims and Objectives: To investigate the trends in access to dental services among adults from the N-E region of Romania and to evaluate the factors that influence access to dental care. Material and Methods: A self-administered questionnaire was used to evaluate the access and utilization of dental care among a sample of adults. We collected data on their demographic characteristics, their type of medical insurance, their monthly income, the type of dental office they visited, their reasons for choosing a certain type of dentist office, and their oral hygiene habits. It was found that their financial status determined by the occupation of the individual, as well as their monthly income, influenced their access to medical services. Data were analyzed using SPSS 20.0. Results: Of a total of 696 participants, 55.6% were female, 83.3% were from urban areas, 42.1% were retired, 62.3% of the subjects utilized dental emergency services, and 67.9% of the subjects self-funded their treatment. The reasons for women not attending dental offices included costs (24.3%) and dental fear (9.8%), while men's reasons were high costs (26.4%) and lack of time (5.9%). Significant differences were recorded between gender and reasons for visiting the dentist (p = 0.018), payment for dental services (p = 0.009), and preferred clinic (p = 0.010). In relation to occupation, there were significant differences for most of the variables evaluated (reasons to visit a dentist, payment for dental services, preferred dental clinic, self-rated oral health, etc.). Conclusions: Gender, occupation, and monthly income levels were found to influence access to dental medicine services of Romanians in the N-E region. Dental services were frequently accessed for emergency reasons. Dental services were found to be paid for by state insurance for those with low monthly incomes and self-funded for those with higher monthly incomes.

A model for implementing oral health-promoting school: Integration with dental students' educational curriculum: A protocol study

BACKGROUND

Schools are ideal setting for children's oral health-promoting programs. It is an integrated model for oral health-promoting schools (OHPS) with the capacities of dental school's curriculum and dental students as workforces. In this protocol, the principle of planning and implementation of the oral health program is described.

MATERIALS AND METHODS

Based on the PRECEDE-Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development (PROCEED) planning model, a framework for determining the potential predisposing, reinforcing, and enabling factors that could be intervening was diagnosed. To adapt the phases of the planning model for integration of the "OHPS" principles and the dental students' curriculum, the following steps are supposed to be considered: Phases 1-5 which are to assess the baseline data will include the assessment of children oral health status and parents and teachers' knowledge, attitude, and performance. Phase 6 or implementation phase will be allocated to oral health education interventions for students, parents, and teachers, professional screening, prevention, and referral. Phase 7 or the process assessment phase will be to record the number of screened students, the amount of fissure sealant and fluoride provision, and percentage of trained parents and teachers. Phase 8 or the impact assessment phase will assess the students' improvement in knowledge and practice, decayed, missing, and filled teeth scores, teachers and mothers' oral health attitudes and behaviors, and brushing and flossing behaviors. At the last, cost analysis of the program and long-term monitoring of the interventions is suggested.

CONCLUSION

In case that the effectiveness of this model is proven, it can be implemented by other dental schools for the primary schools in their regions. Considering the number and distribution of dental schools in the country, this model is executable as targeted population oral health promotion approach in 6-12-year-old schoolchildren.

Investigating Perceptions of Teachers and School Nurses on Child and Adolescent Oral Health in Los Angeles County

This study reports the results of focus groups with school nurses and teachers from elementary, middle, and high schools to explore their perceptions of child and adolescent oral health. Participants included 14 school nurses and 15 teachers (83% female; 31% Hispanic; 21% White; 21% Asian; 14% African American; and 13% Others). Respondents were recruited from Los Angeles County schools and scheduled by school level for six one-hour focus groups using Zoom. Audio recordings were transcribed, reviewed, and saved with anonymization of speaker identities. NVivo software (QSR International, Melbourne, Australia) was used to facilitate content analysis and identify key themes. The nurses’ rate of “Oral Health Education” comments statistically exceeded that of teachers, while teachers had higher rates for “Parental Involvement” and “Mutual Perception” comments. “Need for Care” was perceived to be more prevalent in immigrants to the United States based on student behaviors and complaints. “Access to Care” was seen as primarily the nurses’ responsibilities. Strong relationships between community clinics and schools were viewed by some as integral to students achieving good oral health. The results suggest dimensions and questions important to item development for oral health surveys of children and parents to address screening, management, program assessment, and policy planning.

Lessons Learned From School-Based Delivery of Vision Care in Baltimore, Maryland

ABSTRACT

In an effort to address health care disparities in pediatric eye care, school-based vision programs have been established. These programs, while not universally available, have been established at individual schools or across school districts in at least 20 states in the United States (US). They play a critical role for students who are not accessing eye care, especially in disadvantaged communities. In the US, school-based vision programs often provide vision screenings, eye exams, and eyeglasses directly in the school setting. The rationale for involving schools in vision care delivery is the recognition of the inter-relatedness between health and education, including how poor vision can impact learning. Vision for Baltimore is a citywide school-based vision program that provides vision care for all Baltimore City Public Schools elementary and middle school students (age range 4 to 16 years). The goal of this paper is to summarize lessons learned from our work on clinical outcomes from screenings and eye exams, the academic impact of Vision for Baltimore, and qualitative work about consent challenges and stakeholder engagement. While school-based vision programs may vary in operations, we hope the lessons learned through our work may help demonstrate the transformative impact on vision and learning, as well as the importance of addressing stakeholder needs to maximize impact and ensure program sustainability.

Effect of educational strategy combined with ART on oral health-related quality of life: a controlled clinical trial

This study aimed to assess whether complementing atraumatic restorative treatment (ART) with oral health educational strategies (OHES) improves the perception of oral health-related quality of life (OHRQoL) and clinical oral outcomes. A controlled clinical trial included 93 six- to eight-year-old students from five public schools of Piracicaba, Saltinho, and Charqueada municipalities (State of São Paulo, Brazil) divided into 3 groups (31 children each) which received: OHES (caries-free), ART (dental caries), and ART plus OHES (dental caries). OHRQoL (CPQ8-10-ISF:16), dental caries, biofilm control, and gingivitis were assessed before and 1 month after interventions by one calibrated examiner. OHES consisted of an educational interactive activity performed once a week for four weeks. Data were analyzed using mixed model ANOVA, Chi-square, and Sign tests. After 1 month of follow-up, improvement in gingivitis status, OHRQoL total score, and Functional Limitations, Emotional Well-Being and Social Well-Being domains scores were found in all groups (p < 0.05). The improvement in biofilm control was observed only in the OHES group (p < 0.001; power = 0.98), while a decrease in Oral Symptoms scores was observed only in ART+OHES group (p <0.001; power = 0.99) and a significant change in the perception of oral health was observed in the two groups that received ART (p < 0.05). In conclusion, improvement in overall OHRQoL and oral status was observed in all children, although the effect of including health educational strategies in the treatment plan was determinant for the perception of an improved oral health after restorative treatment.

Recruitment strategies for a pragmatic cluster randomized oral health trial in pediatric primary care settings

Objectives

To describe multilevel recruitment strategies for an ongoing clinical trial in pediatric primary care settings, and assess adoption and reach of these strategies via the RE-AIM framework.

Methods

This study is part of a larger pragmatic cluster randomized clinical trial focused on the effectiveness of interventions on the practice, provider, and caregiver levels on dental utilization for Medicaid-enrolled 3-6 year old children. Pediatric practices were recruited according to the proportion of Medicaid-eligible children, geographic region, and County. In accordance with the RE-AIM framework, providers reached were those approached directly and consented, and those who participated in the intervention training adopted to deliver the intervention. Caregivers reached were those approached and consented at their child's well-child visit to participate in the trial.

Results

Recruitment goals were met over a 21 month period, with an overall enrollment of 18 practices, 62 providers, and 1024 caregivers-child dyads. The majority of practices enrolled were small, suburban, and located in an urban county. The participation rates among approached providers and caregivers was 93% and 84% respectively. Enablers for recruitment was the one-on-one interaction with the provider and caregivers. Barriers to recruitment for caregivers included no-shows and cancellations at well-child visits. Adoption of intervention among providers was high, and caregiver reached were representative of the eligible target population.

Conclusions

Active approaches to recruitment, such as utilizing opinion leaders, in-person recruitment, and building relationships with practice staff, can result in successful enrollment and imp lementation of a multi-level intervention in pediatric primary care settings.

The Children's Health and Maintenance Program (CHAMP): An innovative community outreach oral health promotion program: A randomized trial

OBJECTIVE

To describe CHAMP (Children's Oral Health Promotion Program) evaluating the impact of two motivational methods in increasing dental care access.

METHODS

CHAMP is a multi-dimensional oral health promotion programme that recruited and screened underprivileged children/families from community sites in Los Angeles County between 2012 and 2018. A randomized clinical trial (RCT) enrolled children/families into one or more motivational interventions (intra-oral camera and/or social work consultation) designed to impact subsequent scheduling of dental appointments.

RESULTS

CHAMP served 24 535 families. RCT had 418 families with 68.5% scheduling appointments by second follow-up (P < .001). Excluding children with scheduled appointments by first follow-up, children experiencing both interventions were 4.1 (95% CI 1.5-11.2) times more likely to schedule appointments by second follow-up than were the controls (P=<.01). When experiencing both interventions and had never previously been to the dentist, 68.3% scheduled dental appointments; this was significantly higher than the controls (46.7%) (P = .04). The best predictor for families to have scheduled appointments was a dental visit within the last six months [OR = 3.8 (95% CI 2.2-6.6), P < .001].

CONCLUSIONS

Outreach health promotion programmes are important and should consider utilizing various motivational techniques to encourage enrolment and treatment at dental homes.

The Interprofessional Role in Dental Caries Management: Impact of the Nursing Profession in Early Childhood Caries

Early childhood caries is a major unmet population health care need that negatively affects the overall health of children, especially those from diverse racial/ethnic backgrounds and disadvantaged socioeconomic groups. Nurses and midwives who work with pregnant women to nurses and nurse practitioners who work with young children and their families have an opportunity to positively influence the health of these populations. Primary care settings are ideal for integrating oral health into the overall health care of children and adolescents. The nursing profession is well positioned to have a positive impact on oral health and, in so doing, their overall health.