Socioeconomic Factors and Oral Health-Related Behaviours Associated with Dental Caries in Preschool Children from Central Italy (Province of Ascoli Piceno)

Relevance of Sociocultural Inequalities and Parents' Origins in Relation to the Oral Health of Preschoolers in Lanzarote, Spain

Approaching inequalities to achieve health equity requires joint action. Early childhood caries affects disadvantaged population groups. The objective of this study was to determine the relevance of sociocultural inequalities and parental origin with respect to oral health in preschool children in Lanzarote. A transversal epidemiological study was carried out. Sociocultural data and information about parental origin were collected via a questionnaire. The decayed and filled teeth (dft), decayed teeth (dt), filled teeth (ft), restorative index (RI), plaque index (PI) and gingival index (GI) were obtained via an investigator's examination. Statistical analysis of the data indicated that children of semi-skilled manual workers (28.15%) had the highest prevalence of caries (46.9%). Additionally 43.7 of the mothers had second grade and first cycle studies. When relating the medium and high level of education, there were statistically significant differences in relation to the cod index (p = 0.046). When the origin was foreign (48.4%), preschoolers presented 10.7% more active or untreated caries than Spaniards (p = 0.038). Low socioeconomic cultural level and foreign origin is associated with a more deficient state of oral health in preschoolers. Oral health programs are needed to minimize social inequalities.

Experience and Prevalence of Dental Caries in Migrant and Nonmigrant Low-SES Families’ Children Aged 3 to 5 Years in Italy

Dental caries is a public health problem in children and is more prevalent in low-socioeconomic-status groups. The aim of this study is to assess the association between migrant families and the prevalence of caries among young children in Italy. This is a cross-sectional study. In the age range of 3 to 5 years, a total of 266 migrant children and 301 nonmigrant children were examined in three Italian charity dental centers. All children had families with low SES. The dmft was determined by intraoral examination performed by six pediatric dentist specialists to assess their dental health. In this study, the prevalence of caries (71%) and the mean dmft (3.68; SD: 1.52) of migrant children were statistically significantly higher than the percentage (52%) and the mean dmft of the nonmigrant control group (3.10; SD: 1.65) with no differences between genders. For the migrant children, the mean (0.49; SD: 0.32) of restorations (filled teeth) was statistically significantly lower than that of nonmigrant children (1.20; SD: 0.48). This study highlights that dmft values and the prevalence of caries are higher in migrant children than in nonmigrant children. In addition, the control group shows a higher level of dental caries than the national mean.

Exploring the Relationships between Children's Oral Health and Parents' Oral Health Knowledge, Literacy, Behaviours and Adherence to Recommendations: A Cross-Sectional Survey

Although preventable, early childhood caries (ECC) is a burdening condition in all WHO regions, with Poland being one of the most affected countries in Europe. Effective home-based prevention of ECC is available and recommended by several expert bodies. Therefore, we wanted to determine how well parents were following selected oral health recommendations in preschool children. Additionally, we wanted to determine which socioeconomic factors influenced such practices the most, and how parents' oral health literacy and behaviours affected the oral hygiene and oral health status of their children. A cross-sectional survey involving 2338 parents and caregivers of children from 167 kindergartens was performed. Children's oral hygiene and oral health status were found to be associated with parents' education and economic status. They were also strongly influenced by parental health literacy and behaviours. With respect to recommendations for preschoolers, the lowest adherence was found in the use of fluoride toothpaste and its age-appropriate amount, supervision of toothbrushing, and refraining from eating after last toothbrushing. The improvement in these areas could be achieved thanks to the involvement of health professionals such as gynaecologists, midwives, and primary care personnel in efforts aimed at increasing parents' oral health knowledge and literacy.

An educational intervention using the health belief model for improvement of oral health behavior in grade-schoolers: a randomized controlled trial

Background

Oral health problems especially dental caries are common in school children, and education programs may help to prevent these conditions. The aim of current study was to examine the effects of an educational program based on a Health Belief Model (HBM) to improve oral health behaviors of elementary school children.

Methods

A total of 112 children ages 6–12 years old accompanied by one of their parents were randomly assigned to intervention/test and control groups. In the intervention group, five consecutive weekly educational sessions based on the HBM were provided, while the control group received only routine education delivered by the dental clinic. The Decayed, Missing, and Filled Teeth (DMFT) score, papillary bleeding index, and responses to the HBM questionnaire were assessed in the intervention and control groups at baseline and three-month follow-up after the intervention was completed. Within-group and between-group differences were examined using the Student’s t-test and analysis of covariance.

Results

All HBM domains were improved at follow-up in the intervention group compared to the control group (p < 0.001). The largest change was in perceived susceptibility, whereas the smallest changes were in perceived severity and perceived benefits. The papillary bleeding index demonstrated a significant change from baseline to follow-up in the intervention group (reduction of 0.7, 95% CI = − 0.9 to − 0.5). All components of the DMFT score except missing teeth also improved in the intervention group compared to controls. However, no significant difference was found in total DMFT score between intervention and control groups.

Conclusion

An education program based on HBM may be more effective than current methods used to educate children and their parents on optimal oral health behaviors. Administration of interventions of this type along with other school-based programs to prevent dental caries may be helpful in grade-school children.

Inequalities in utilization and provision of dental services: a scoping review

BACKGROUND

There are many determinants that can affect inequality in oral and dental health. This study is aimed to explore the main determinants of inequality in both utilization and provision of dental services in Organization for Economic Co-operation and Development (OECD) countries.

METHODS

Four databases including PubMed, ISI WOS, Scopus, and ProQuest were searched up to 8 Aug 2020, applying the relevant keywords. Thematic analysis was used for synthesizing and extracting data. Trend analysis was applied to determine the trends of the inequality determinants.

RESULTS

Thematic analysis led to 6 main themes, 13 sub-themes, and 53 sub-sub-themes. The main themes represent the main inequality determinants for both utilization and provision of dental services. The streamgraph illustrated that fewer studies have been conducted on social and cultural determinants, and for almost all determinants the trend of published articles has been increasing since 2007, with the exception of health policies.

CONCLUSIONS

Inequality in the utilization and provision of dental services is addressed by various factors including individual, social, cultural and economic determinants, health policies, and availability of services. The first four determinants are related to utilization and the last two are related to the provision of services. All these aspects must be considered to reduce inequality in dental services.

Anthropometric Status, Diet, and Dental Caries among Schoolchildren

Childhood dental caries and obesity are prevalent health problems. Results from previous studies of the caries–obesity relationship are conflicting. This study aimed to assess the association between anthropometric status and dental caries among schoolchildren, taking into account dietary habits, oral hygiene, and sociodemographic factors. This cross-sectional study recruited 569 children aged 6–12 years from five elementary schools in central Taiwan. Each child underwent an oral health examination and anthropometric measurements. The DMFT (decayed, missing due to caries, and filled permanent teeth) and deft (decayed, extracted, and filled primary teeth) indexes were calculated to record caries experience. A structured questionnaire was used to collect information on food intake frequency and other related factors. The World Health Organization’s reference data was applied to define weight status: obese, overweight, and normal/underweight. The results showed that the mean (±standard deviation) deft and DMFT scores were 2.3 ± 2.6 and 0.7 ± 1.2, respectively, among participating children. The prevalence of obesity and overweight was 18.1% and 18.5%, respectively. After comprehensive evaluation of potential confounders, weight status was not an independent predictor of DMFT or deft scores in the negative binomial regression models. In conclusion, weight status was not associated with caries scores in primary or permanent teeth among 6–12 year-old schoolchildren.

Confirmatory Factor Analysis of Knowledge, Attitude, and Behaviour Questionnaire towards Oral Health among Indian Adults

Background: Oral health-related conditions are among the common conditions seen in adults in India. The usage of inappropriate measurement tools that are unvalidated may result in deceptive and imprecise findings that might lead to substandard plans for cessation programs and ineffectiveness. This study was conducted to validate a questionnaire that can assess the factor structure of knowledge, attitude, and behaviour towards oral health among adults in India by confirmatory factor analysis. Methods: Simple random sampling was conducted among adults in India. A total of 260 adults participated in this study. The knowledge, attitude, and behaviour (KAB) questionnaire on oral health was circulated among the adults who were willing to participate in the study after it was explained to them, and the questionnaires were retrieved once they completed. Software R version 3.6 was used to analyse the data of this study. Robust maximum likelihood was utilized for the assessment due to the violation of multivariate normality assumption. For attitude and behaviour domain, a three-factor model was used for measurement model validity and construct validity. Results: The confirmatory factor analysis of the three-factor model for the 26-item KAB questionnaire on oral health gave sufficient goodness-of-fit values and the measurement model exhibited ideal convergent and discriminant validity following model re-specification. The three-factor model was tested to obtain measurement model validity and construct validity for attitude and behaviour domains. The results of this study gave a statistically significant value (p < 0.001), with χ² (df) values of 39 (7) and 28 (11) for attitude and behaviour domains, respectively. Conclusions: The KAB oral health questionnaire used in this study has a valid measurement model and reliable constructs. It was found to be an ideal tool to measure the KAB towards oral health among adults in India.

Assessment of Brushing Techniques in School Children and Its Association with Dental Caries, Omdurman, 2019

Background

Dental caries are a common infectious disease of childhood. It is a highly prevalent disease among children.

Aim

The goal of this study was to assess the different brushing techniques used by school children and to identify if there is an association between brushing techniques and dental caries.

Materials and Methods

A descriptive cross-sectional study was carried out among 396 school children (9-12 years old) chosen by convenience sampling technique from schools located in Omdurman locality, Sudan. After consent was taken, students were asked in an interview-based questionnaire about their brushing habits. Consequently, they were examined in an upright position using a sterile mouth mirror and a probe. The examination was carried out by a single examiner to investigate the presence of dental caries. The diagnosis was done based on the World Health Organization diagnostic criteria 2013. The data were analyzed through descriptive statistics and comparison between values using the chi-square test with a P value <0.05.

Results

The present study found that the prevalence of dental caries is 70.9%. The combined brushing technique was the most used technique (42.9%). There was no statistical significance between brushing techniques and dental caries (P value ≤0.330). There was a statistical significance between the periodic change of the toothbrush and dental caries (P value ≤0.001). There was statistical significance between the level of education of the mother (P value ≤0.001) and father (P value ≤0.012) to the brushing technique used by the child as well.

Conclusion

Due to a lack of awareness consequent of lower socioeconomic status, only a few percentage of the Sudanese population knows how to implement the correct oral hygiene practices to combat dental caries. It is important to design a specific public health program that particularly targets families of low socioeconomic status, which represents the majority. Dental caries persist as a widespread condition in Sudan as a result of a deficit in these kinds of programs.

The Burden of Early Childhood Caries in Children under 5 Years Old in the European Union and Associated Risk Factors: An Ecological Study

The associations among early childhood caries (ECC), socioeconomic status, and sugar consumption are of the utmost importance, due to their potential policy implications. The purpose of this study was to identify trends in ECC burden in children under 5 years old among European Union (EU) member states over time and to evaluate the relationship with its risk factors. Global Burden of Disease 2019 data were analyzed to estimate the burden of ECC over time, specifically incidence, prevalence, and years lived with disability (YLDs) for children under 5 years old. Four ecological variables with a potential effect on YLDs for ECC were used to investigate the association between 2014 and 2017. The YLDs rate was consistently higher among Eastern EU countries over time. Univariate models showed a positive significant association between at-risk-of-poverty rate and YLDs rate, while GDP per capita and urbanization were inversely associated with YLDs rate. In the multivariate analysis, sugar consumption, GDP per capita and urbanization showed significant association with YLDs rate. After stratification by region, association remained significant only in the Eastern EU countries between GDP, urbanization, and YLDs rate, while sugar consumption and at-risk-of-poverty rate had no significant impact on YLDs rates. This study found increasing ECC burden in the EU. The complexity of the problem indicates the need for innovative and personalized policy approaches to tackle the disease.

Impact of Lifestyle Variables on Oral Diseases and Oral Health-Related Quality of Life in Children of Milan (Italy)

A large part of the Italian population doesn’t receive adequate information and support on how to maintain oral health. In this observational, cross-sectional, pilot study, we investigated how some lifestyle-related variables affect oral diseases and oral health-related quality of life (OHRQoL) of children attending public-school summer services in Milan. A survey that included questions on children’s oral disease, OHRQoL and lifestyle-related factors (feeding habits, oral hygiene protective behaviors, dental coaching and socio-economic and educational status), was administered to the children’s caregivers. Data from 296 surveys were analyzed to assess the protective/negative effect of each variable on oral disease and OHRQoL. With respect to disease, the “never” consumption of fruit juice, the use of fluoride toothpaste, higher educational qualification and ISEE (equivalent family income) of those who filled out the form, resulted protective factors. Regarding OHRQoL, the “never” assumption/use of tea bottle, sugared pacifier and fruit juice as well as the use of fluoride toothpaste, a higher educational qualification and ISEE of those who filled out the form, resulted to have protective effects. In conclusion, protective behaviors and socio-economic status affect oral disease and OHRQoL in children of Milan.

Perception of Dental Caries and Parental Difficulties in Implementing Oral Hygiene for Children Aged Less Than 6 Years: A Qualitative Study

BACKGROUND

Despite extensive prevention programs, dental hygiene remains inadequate, particularly among children under the age of six, and early childhood caries (ECC) are still a concern. Oral hygiene behavior and preventive practices seem difficult to change at a family level.

AIM

The present study aimed to better understand the reasons behind this behavior and to identify the different barriers to the implementation of adequate preventive measures.

METHODS

A qualitative study was conducted in the pediatric dentistry service of the Montpellier University Hospital (France) in 2019. A thematic analysis concerning three domains was performed: family environment, dental literacy, and oral hygiene.

RESULTS

The main barriers encountered by the parents were, respectively, (1) a weakness in the organization of familial life, together with a low-medium family income and a lack of authority, (2) ignorance of the necessity of treating carious primary teeth, and (3) a lack of time for brushing or supervising their children's teeth.

CONCLUSION

These results showed that oral hygiene and primary teeth care could not be easily achieved in the family environment of the participants, and oral health strategies should be focused not only on children but also on their parents.

Developmental Enamel Defects (DDE) and Their Association with Oral Health, Preventive Procedures, and Children's Psychosocial Attitudes towards Home Oral Hygiene: A Cross-Sectional Study

Background: Developmental enamel defects (DDE) exert significant effects both on esthetics and occlusal function and prevention should be the general clinical approach to DDE. The purpose of this cross-sectional study was, therefore, to detect, within a pediatric sample, any significant association between DDE and children’s psychosocial attitudes towards home oral hygiene, as well as potential associations between primary preventive procedures and DDE. Methods: 394 schoolchildren (197 males and 197 females, 8.9 ± 1.4 years) underwent an intra-oral examination; they were then interviewed with a brief questionnaire. Results: 5–6% and 12–14% of participants had, respectively at least one molar and one incisor affected by DDE. In general, no associations were observed in the examined clinical categories (caries and other oral health indices). A strong relationship was found between the presence of molar DDE and children’s positive vs. negative psychosocial attitudes towards home oral hygiene. Conclusions: The probability of finding DDE in our sample of examined children was approximately more than doubled for children with negative psychosocial attitudes towards home oral hygiene, than for children with positive attitudes towards home oral hygiene.

Prevalence of Caries and Associated Risk Factors in a Representative Group of Preschool Children from an Urban Area with High Income in Milan Province, Italy

The present survey provides a quantitative assessment of caries prevalence, covering a group of 3–5 year-old children from an urban area generally with a high income in the province of Milan, and a comparison of the obtained results with the data presented by the W.H.O. A cross-sectional study was conducted in the period from March to September 2018 to investigate the prevalence of caries in a sample of 160 children (82 females and 78 males). The absence/presence of caries was defined as a dependent variable. Factors concerning lifestyle, diet, oral habits, oral hygiene, the presence and type of malocclusion and mouth breathing attitude were considered as risk factors. Data were analyzed by Chi-square (χ2) and regression tests using SPSS (version 25.0) software. In total, 84.38% of children (135 out of 160) showed no caries. A regression analysis demonstrated that children who had already received an early first dental visit were mostly those already affected by caries. Furthermore, children who had four meals daily or more were less exposed to the risk of developing caries compared to those who had only 1–3 meals daily. The caries prevalence of preschool children from urban areas with a high income in Milan province is relatively close to that considered acceptable by the W.H.O. in its proposed goals for the year 2020. Therefore, it can be concluded from the obtained results that there is a possibility for further improvement in preventing caries growth at its initial stage: it is necessary for the number of meals daily consumed by children to be controlled by parents, and conducting a dental visit early in childhood must not be neglected.

Oral Hygiene in a Sample of Children/Adolescents Living in Family-Homes from the Province of Milan (Italy): A Pilot Study

Objective: This pilot study is a prospective controlled clinical trial, designed to evaluate the short-term clinical results (the plaque index) of an educational/motivational program for home oral hygiene, directed to children and adolescents who live in family-homes. Methods: The setting of the project was the province of Milan (Italy), where two family-homes were selected. The study group included 26 children (16 females and 10 males) aged between 7 and 15 years, of Italian nationality, from the family-home communities. The control group included 26 children (15 females and 11 males, aged between 7 and 15 years) of Italian nationality, matched for age and gender distribution with the study group, that were not in a socially disadvantaged condition. Collection of the plaque index (PI) was performed at t0. Then, all basic oral hygiene instructions were given to all children/adolescents and their educators. Education and motivation were repeated in the same way after 4–7 weeks (T1), and after 10–12 weeks (T2). The PI was taken also at T1 and T2. Results: An improvement in the PI was generally found in both groups, but there was no statistically significant difference between the two groups over time. Multivariate analysis of variance (MANOVA) revealed a statistically significant effect of time [F (1, 52) = 90.73, p < 0.001], regardless of the assignment group, in consequence of which the plaque index presented a moderate and significant improvement. Conclusion: The present data confirm the validity of the educational/motivational program to improve oral hygiene in children/adolescents, regardless of the assignment group.