Research in dental health education and health promotion: a review of the literature

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

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

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

Background

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

Methods

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

Results

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

Conclusions

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

Effectiveness of oral health education intervention among 12-15-year-old school children in Dharan, Nepal: a randomized controlled trial

Background

School-aged adolescents are in particular need of preventive program to ensure positive long-term oral health and hygiene. The objective of this study was to assess the effectiveness of an oral health education (OHE) intervention on oral hygiene knowledge, attitude and practices (KAP), plaque control and gingival health among 12–15 years old school children in Dharan sub-metropolitan city, Nepal.

Methods

A randomized controlled trial was conducted with parallel study groups, comprising 12–15-year-old school children, 120 in each group. OHE was given to the experimental group at baseline, third and sixth months and to the control group after completion of the study. Interview of the participants were done using a 23-item questionnaire for assessment of oral hygiene KAP. For each question, correct answer was scored as 1 and wrong answer was scored zero. An overall composite score was then created, by adding the individual scores. Oral examination was done using mouth mirror and WHO probe to record Turesky–Gilmore–Glickman modification of the Quigley-Hein plaque index, Gingival index and Dentition status and treatment needs. Analysis was done using chi-square test for categorical data and independent t test, Mann–Whitney U test, repeated measures ANOVA and post hoc Tukey’s test for quantitative data. The level of significance was set at P < 0.05.

Results

There was 54.58% improvement in overall oral hygiene KAP in experimental group (P = 0.001) whereas no improvement was seen in control group at the end of the study. The mean plaque score was improved by 57.67% (P = 0.001) in experimental group in comparison to 4.56% in control group. Gingival index was improved by 49.90% (P = 0.001) in experimental group in comparison to 0.7% in control group. Caries experience was increased in both groups but no significant difference was seen.

Conclusions

The study concluded that oral health education was effective in improving oral hygiene KAP, plaque control and gingival health.

Trial registration The trial was retrospectively registered with Clinical Trial Registry India (CTRI) with identifier no. CTRI/2018/05/013985, registered on 05/21/2018. (http://www.ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=23651&EncHid=&modid=&compid=%27,%2723651det%27). Institutional Review Committee, B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal provided the ethical approval (Ref. No.: 292/074/075-IRC).

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Oral health academics' conceptualisation of health promotion and perceived barriers and opportunities in dental practice: a qualitative study

BACKGROUND

Oral diseases place a significant burden on individual and population health. These diseases are largely preventable; health promotion initiatives have been shown to decrease the disease rates. However, there is limited implementation of health promotion in dentistry, this could be due to a number of factors; the ethos and philosophy of dentistry is focused on a curative, individualised approach to oral diseases, confusion around health promotion as a concept. Oral health academics are well placed to implement health promotion, training of these professionals needs to include prevention, as training influences dental practice. However, there is a little understanding about how oral health academics (dental professionals who educate dental and oral health students) view health promotion. The aim of this exploratory study is to understand how oral health academics conceptualise health promotion and perceive the barriers and possible opportunities for health promotion implementation in dental practice.

METHODS

Nominal group technique (NGT), a highly structured face-to-face meeting, was conducted with 24 oral health academics to explore how they conceptualize health promotion and the barriers and opportunities for health promotion in practice. An additional 4 questions were emailed to oral health educators after the NGT meeting to gather additional data, 6 oral health academics were involved. The data was analyzed using thematic analysis.

RESULTS

Three board themes were identified: "Knowledge, ideas and concepts of health promotion", "Challenges to health promotion", "Opportunities for health promotion practice". The oral health academics in this study discussed health promotion in a holistic way, however, health education and behaviour change were mentioned more than other aspects of health promotion. The structure of dental practice specifically the curative approach that underpins dentistry and the lack of funding, and value placed on health promotion could act as a challenge to health promotion being implemented in practice. There has been a shift towards prevention in dentistry, however the participants acknowledge there needs to be a change in the curative culture of the profession. Collaboration with other health professionals and using a common risk factor approach were the identified opportunities for health promotion practice.

CONCLUSIONS

Oral health academics have a holistic understanding of health promotion, but still focus more on behavioural approaches which is common within dentistry. For a change to occur in health promotion practice a change in the structure, curative approach and funding model of dentistry is required. Collaboration with other health professionals is an opportunity to be capitalised on. Training of future dental professionals is the perfect place to start to implement the changes and opportunities for health promotion presented in this paper.

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

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

Teaching Oral Hygiene Skills to Elementary Students with Visual Impairments

This study investigated the effects of a program that taught oral hygiene skills to students with visual impairments using group instruction and individual coaching. The results showed that the program enhanced the oral hygiene skills of the three participants significantly, and its effectiveness lasted for at least two months after the instruction ended.

A public health perspective on personalized periodontics

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

Effectiveness of oral health education intervention among female primary school children in Riyadh, Saudi Arabia

Objective

This study aimed to examine the effectiveness of oral health intervention on the improvement in knowledge and self-reported oral health behavior among 6–8 year old female primary school children in Riyadh, Saudi Arabia.

Materials and methods

The sample consisted of 1661 girls in primary schools who are 6 to 8-year-olds (first, second and third graders). The children’s level of knowledge was assessed by a self-administered questionnaire that was formulated for this specific age and divided into two parts; oral health knowledge and self-reported oral health behavior. There were seven multiple choice questions and one true/false question with five underlying parts in the questionnaire which contained basic information about oral health knowledge, oral hygiene practices and certain habits that affect teeth. The questionnaires were distributed before and six weeks after implementation of the oral health educational program to measure the level improvement of knowledge regarding oral health among these children.

Results

All the questions showed statistically significant improvement in knowledge and self-reported behavior in the post intervention group. There was a significant increase in the level of knowledge by 11.24% and level of self-reported behavior by 25% after intervention (P < 0.001). The highest net change in the knowledge due to intervention was noted among third graders (13.3%), whereas for self-reported oral health behavior, it was noted among first graders (28.3%).

Conclusion

The results of this study showed that an easy-to-organize and inexpensive school-based intervention can, on a short-term basis, be effective in improving the knowledge and self-reported oral health behavior of children.

Complex patterns of response to oral hygiene instructions: longitudinal evaluation of periodontal patients

Background

Oral hygiene instruction is an intervention widely practiced but increased knowledge about oral health does not necessarily dramatically impact oral disease prevalence in populations. We aimed to measure plaque and bleeding in periodontal patients over time to determine patterns of patient response to oral hygiene instructions.

Methods

Longitudinal plaque and bleeding index data were evaluated in 227 periodontal patients to determine the impact of oral hygiene instructions. Over multiple visits, we determined relative plaque accumulation and gingival bleeding for each patient. Subsequently, we grouped them in three types of oral hygiene status in response to initial instructions, using the longitudinal data over the period they were treated and followed for their periodontal needs. These patterns of oral hygiene based on the plaque and gingival bleeding indexes were evaluated based on age, sex, ethnic background, interleukin 1 alpha and beta genotypes, diabetes status, smoking habits, and other concomitant diseases. Chi-square and Fisher’s exact tests were used to determine if any differences between these variables were statistically significant with alpha set at 0.05.

Results

Three patterns in response to oral hygiene instructions emerged. Plaque and gingival bleeding indexes improved, worsened, or fluctuated over time in the periodontal patients studied. Out of all the confounders considered, only ethnic background showed statistically significant differences. White individuals more often than other ethnic groups fluctuated in regards to oral hygiene quality after instructions.

Conclusions

There are different responses to professional oral hygiene instructions. These responses may be related to ethnicity.

Electronic supplementary material

The online version of this article (10.1186/s12903-018-0537-z) contains supplementary material, which is available to authorized users.

Psychology of behaviour change is key to effective oral health promotion

Data sourcesAMED, CINAHL, Cochrane Library, Embase, Medline, PsycINFO, PsycARTICLES, ScienceDirect, SocINDEX, ASSIA, Social Policy and Practice, HMIC (Health Management Information Consortium), The Knowledge Network, Intute, MedNar, Copac, EPPI-Centre, EThOS, OpenGrey and TRIP databases. Searches were limited to publications in the English language published after 1994.Study selectionStudies set in general practice that investigated promoting good oral health in adult or child patients were considered. Study quality was assessed using NICE public health guidance checklists.Data extraction and synthesisStudies were grouped according to the evidence they offered in relation to the research questions and key findings and themes identified. No meta-analysis was conducted. Qualitative studies underwent thematic analysis. The evidence was synthesised after considering the studies' homogeneity, quality and applicability and studying the evidence tables.ResultsForty-four studies reported in 52 papers were considered. Fifteen studies were randomised controlled trials (RCTs), two cluster RCTs and one controlled trial. Five quasi-experimental studies, two before and after studies without controls, three surveys, 11 qualitative studies, three mixed methods studies, one audit and one pilot study were included.The studies were very heterogeneous; the quality of reporting highly variable with many using patient reported behaviours rather than objective measures. Follow-up periods were also short. Narrative summaries of psychological and behavioural models, verbal advice, written advice, other methods of conveying advice, message content, sender characteristics, receiver factors, 'framing' of advice, barriers and facilitators and patient satisfaction were provided.ConclusionsThe results of this review suggest that the psychology of behaviour change is the key to oral health promotion, and greater emphasis on teaching oral health professionals about health psychology would make oral health promotion in the dental surgery more effective.

Effect of Training School Teachers on Oral Hygiene Status of 8-10 Years Old Government School Children of Udaipur City, India

INTRODUCTION

Provision of oral health knowledge to the children by their teachers at the school level can prove to be more fruitful because it is the time period during which the children begin to learn the basic oral hygiene practices and are most prone to dental caries.

AIM

This study was carried out to assess the effect of training school teachers on oral hygiene status of 8-10 years old government school children of Udaipur city, India.

MATERIALS AND METHODS

A total of nine school teachers and 279, 8-10 year old school children from two government schools were included in the study. The questionnaire on oral health knowledge and practice contained 17 questions to evaluate the knowledge and practice of children towards oral hygiene before and after the teachers training program. Baseline and six months post training data on oral health knowledge and practice was obtained by the questionnaire method. Baseline and six months post training data on oral hygiene status was obtained by OHI-S Index. Statistical analysis was done using software SPSS 22, the test used were McNemar's test, paired t-test.

RESULTS

Pre and post training data were compared and it was found that there was a significant improvement in oral health knowledge and practices of school teachers and children. Also oral hygiene status of school children was significantly improved after the program.

CONCLUSION

Results of the present study suggest that experiential learning is an effective school based oral health education method for improvement of oral hygiene in primary school children.

Effectiveness of Peer Group and Conventional Method (Dentist) of Oral Health Education Programme Among 12-15 year Old School Children - A Randomized Controlled Trial

INTRODUCTION

Oral Health Education (OHE) in schools is routinely delivered by the dentist. Another approach which can be cost-effective, easily accessible and equally effective is the trained group of peer students.

AIM

The objective of the present study was to assess and compare the effectiveness of peer-led and conventional method (dentist-led), OHE on oral health status, oral health knowledge, attitude and practices among 12-15 year old government school children in Bengaluru South Zone-I at baseline, 3 months and 6 months.

MATERIALS AND METHODS

The study population comprised of 450 subjects, 150 each in peer, dentist and control group. At baseline, a pre-tested 14 item questionnaire was used to assess the existing oral health knowledge, attitude and oral hygiene practices of the subjects. Clinical examination included recording of plaque index and gingival index, by a pre-calibrated examiner. OHE was provided by the peer group and dentist (using power-point presentation, chalk and talk presentation, using charts, posters, booklets and tooth brushing demonstration models). Data was analyzed using Kruskal Wallis and Chi-square test.

RESULTS

Both the peer-led and dentist-led OHE intervention were effective in improving oral health knowledge, attitude, oral hygiene practices and oral health status at three and six months when compared to control group. The adolescents in the peer-led group, however, exhibited statistically better oral health behavior than their counterparts in the dentist-led group and control group.

CONCLUSION

The two educator-led strategies (peer group and dentist) had a modest effect on the outcome variables included in the study, the results provide some evidence to show that the peer-led strategy may provide a feasible and almost equally effective alternative to the traditional dentist led strategy of oral health education.

A review of approaches for dental practice teams for promoting oral health

To determine the circumstances in which oral health promotion (OHP) in General Dental Practice is at its most effective, a systematic review was conducted to identify, critically appraise and synthesize the available evidence. The research question was: Is oral health promotion within dental practice effective and how can its effects be optimized? Systematic searches of 20 online resources (including Ovid Medline and Embase) were conducted. A call for evidence was also issued, and citation lists of other relevant systematic reviews were included. All studies published since 1994 which were set in the context of general dental practice and investigated promoting good oral health in adult or child patients were considered. 44 studies reported in 52 papers were included in the review. The evidence was heterogeneous and the quality of reporting was variable. Results showed that oral health promotion based on behavioural and psychological models was effective for improving oral health. Verbal advice affected knowledge and reported behaviour, written advice promoted oral health knowledge. There was moderate evidence that the attributes of the 'sender' of an oral health promotion message influenced its effectiveness. Many barriers and facilitators were shown to influence the effectiveness of OHP in dental practice. The results of this review suggest that the psychology of behaviour change is the key to oral health promotion and greater emphasis on teaching oral health professionals about health psychology would make oral health promotion in the dental surgery more effective.

Advancing Health Promotion in Dentistry: Articulating an Integrative Approach to Coaching Oral Health Behavior Change in the Dental Setting

Oral health is managed based on objective measures such as the presence and severity of dental caries and periodontal disease. In recent years, oral health researchers and practitioners have shown increasing interest in a widened array of physical, psychological, and social factors found to influence patients' oral health. In this article, we introduce a behavior change coaching approach that can be used to enhance psychosocial diagnosis and client-centered delivery of health-promoting interventions. Briefly, this health coaching approach is based on an interactive assessment (both physical and psychological), a non-judgmental exploration of patients' knowledge, attitudes, and beliefs, a mapping of patient behaviors that may contribute to disease progression, gauging patient motivation, and tailoring health communication to encourage health-promoting behavior change. Developed in a clinical setting, this coaching model is supported by interdisciplinary theory, research, and practice on health behavior change. We suggest that, with supervision, this coaching process may be learned.

Life course experiences and lay diagnosis explain low-income parents' child dental decisions: a qualitative study

OBJECTIVE

This study aimed to better understand low-income parents' child dental care decisions through a life course approach that captured parents' experiences within the social context of poverty.

METHODS

We conducted 43 qualitative life history interviews with 10 parents, who were long-term social assistance recipients living in Montreal, Canada. Thematic analysis involved interview debriefing, transcript coding, theme identification and data interpretation.

RESULTS

Our interviews identified two emergent themes: lay diagnosis and parental oral health management. Parents described a process of 'lay diagnosis' that consisted of examining their children's teeth and interpreting their children's oral signs and symptoms based on their observations. These lay diagnoses were also shaped by their own dental crises, care experiences and oral health knowledge gained across a life course of poverty and dental disadvantage. Parents' management strategies included monitoring and managing their children's oral health themselves or by seeking professional recourse. Parents' management strategies were influenced both by their lay diagnoses and their perceived ability to manage their children's oral health. Parents felt responsible for their children's dental care, empowered to manage their oral health and sometimes forgo dental visits for their children because of their own self-management life history.

CONCLUSION

This original approach revealed insights that help to understand why low-income parents may underutilize free dental services. Further research should consider how dental programs can nurture parental empowerment and capitalize on parents' perceived ability to diagnose and manage their children's oral health.

Validation of a pediatric oral health-related quality of life scale in Navajo children

BACKGROUND

American Indian (AI) children experience the highest rates of early childhood caries (ECC) in the USA, yet no tool has been validated to measure the impact of ECC on their oral health-related quality of life (OHRQoL).

OBJECTIVE

To validate a pediatric OHRQoL scale in a preschool, rural, reservation-based AI population.

METHODS

In 2011 and 2012, we measured the OHRQoL of AI children attending Head Start in Navajo Nation with the 12-item preschool version of the pediatric oral health-related quality of life (POQL) scale administered to their parents/caregivers. Parents/caregivers also reported their children's subjective oral health status (OHS) and oral health behavior adherence. Concurrently, calibrated dental examiners measured the children's decayed, missing, and filled tooth surfaces (dmfs). Validation was assessed with internal reliability and convergent and divergent validity testing and exploratory factor analyses.

RESULTS

We measured the outcomes in 928 caregiver-child dyads. All children were AI and in preschool [mean (SD) child age was 4.1 (0.5) years]. The majority of children had experienced decay [dmfs: 89 %, mean (SD): 21.5 (19.9)] and active decay [any ds: 70 %, mean (SD): 6.0 (8.3)]. The mean (SD) overall POQL score was 4.0 (9.0). The POQL scale demonstrated high internal consistency reliability (Cronbach alpha = 0.87). Convergent validity of the POQL scale was established with highly significant associations between POQL and caries experience, OHS, and adherence to oral health behaviors (all ps < 0.0001).

CONCLUSIONS

The POQL scale is a reliable and valid measure of OHRQoL in preschoolers from the Navajo Nation.

Self-reported changes in using fluoride toothpaste among older adults in Sweden: an intervention study

OBJECTIVE

The aim of the study was to investigate the possibility of increasing knowledge about the caries-reducing effects of fluoride (F) toothpaste and to increase the use of F toothpaste among older adults through an intervention.

MATERIALS AND METHODS

63-67-year-olds in Sweden, who 2 years earlier had answered a questionnaire about their knowledge of F toothpaste, toothbrushing and toothpaste habits and who had shown less favourable habits with regard to toothpaste use, were invited to participate. The 20-min intervention, performed at a Public Dental Clinic, was implemented by a dental hygienist (author OJ) and consisted of individual information and instruction on the use of F toothpaste. The questionnaire was repeated 4 months after the intervention and a population in another city in Sweden served as control.

RESULTS

In the intervention group, 68 individuals responded and 151 in the control group. Knowledge of the benefits of F toothpaste in the intervention group had improved between the times of the first and second questionnaires, but the same effect was also noted in the control group. After the intervention, a clear improvement concerning the use of F toothpaste was reported: the individuals brushed for a longer time, used more toothpaste and used less water during and after brushing. In the control group, there were no changes of habits between the first and second occasions.

CONCLUSION

Individually-based interventions performed by a dental hygienist had a positive effect on changing the way older adults used F toothpaste.

Challenges in designing, conducting, and reporting oral health behavioral intervention studies in primary school age children: methodological issues

Often within oral health, clinical outcome measures dominate trial design rather than behavioral outcome measures, and often there is a reliance on proxy self-reporting of children's behavior with no corroboration through triangulation of measures. The complexity of the interventions involved in oral health intervention is often overlooked in trial design, and more flexible pragmatic designs that take account of the research context may be more appropriate. Some of the limitations in oral health behavioral intervention studies (trials) in primary school age children were reported in a recently published Cochrane review. This paper aims to critically discuss the findings of a recent Cochrane review in terms of the methodological implications that arise for future design, development, measurement, and reporting of oral health trials in primary school age children. Key components of the UK Medical Research Council's framework for the design and evaluation of complex interventions are discussed in relation to using taxonomies of behavior change. This paper is not designed to be a definitive guide but aims to bring learning from other areas of public health and health promotion into dental public health. Ultimately, the aim is to aid the design of more successful interventions that produce long-term behavioral changes in children in relation to toothbrushing and nighttime sugar snacking.

Effectiveness of motivational interviewing at improving oral health: a systematic review

OBJECTIVE

To analyze the effectiveness of motivational interviewing (MI) at improving oral health behaviors (oral hygiene habits, sugar consumption, dental services utilization or use of fluoride) and dental clinical outcomes (dental plaque, dental caries and periodontal status).

METHODS

A systematic search of PubMed, LILACS, SciELO, PsyINFO, Cochrane and Google Scholar bibliographic databases was conducted looking for intervention studies that investigated MI as the main approach to improving the oral health outcomes investigated.

RESULTS

Of the 78 articles found, ten met the inclusion criteria, all based on randomized controlled trials. Most studies (n = 8) assessed multiple outcomes. Five interventions assessed the impact of MI on oral health behaviors and nine on clinical outcomes (three on dental caries, six on dental plaque, four on gingivitis and three on periodontal pockets). Better quality of evidence was provided by studies that investigated dental caries, which also had the largest population samples. The evidence of the effect of MI on improving oral health outcomes is conflicting. Four studies reported positive effects of MI on oral health outcomes whereas another four showed null effect. In two interventions, the actual difference between groups was not reported or able to be recalculated.

CONCLUSIONS

We found inconclusive effectiveness for most oral health outcomes. We need more and better designed and reported interventions to fully assess the impact of MI on oral health and understand the appropriate dosage for the counseling interventions.

Effectiveness of oral health education in children - a systematic review of current evidence (2005-2011)

BACKGROUND

So that resources and manpower are allocated in a way of most benefit to the population, systematic review of available evidence on the effectiveness of programmes and interventions is required.

OBJECTIVES

To assess the quality of evidence presented in studies carried out to investigate the effectiveness of oral health education in children.

METHODS

The MEDLINE (PubMed) bibliographic database was searched for English-language articles published from 2005 to 2011. Fifty-five articles were identified by the literature search, and the relevance of each article was determined by examining the title and the abstract. Sixteen original research studies met the inclusion criteria. These articles were read in full and scored independently by two reviewers, with scoring based on predetermined criteria. Articles scoring less than 10 were excluded from the study. For each paper that achieved a validity score of more than 10 (n = 11), data concerning the objectives of the intervention, the types and numbers of participants and the outcomes were extracted from the article. Considering the absence of homogeneity among the articles (as a result of variation in the age of subjects, type of intervention and outcome measures) quantitative analysis was not conducted. The publications were grouped based on their outcome measures: (i) plaque and gingival health; (ii) caries incidence; (iii) knowledge, attitude and oral health-related behaviour; and (iv) toothbrushing skills.

RESULTS

The results of this analysis suggest that further efforts are required to synthesise, systematically, current information about dental health education, along with the maintenance of rigorous scientific standards in research.

Relationship of locus of control with plaque and gingival status before and after oral health education in a group of college students - an experimental study

OBJECTIVES

In health psychology, several models are being constructed to understand human behaviour. Multidimensional health locus of control (MHLC) is one among them. We sought to know the relationship of MHLC with dental plaque and gingival status before and after oral health education programme among 286 college students, aged 18-21 years in Davangere city.

METHODS

Multidimensional health locus of control questionnaire consisting of questions measuring internal health locus of control (IHLC), powerful others health locus of control (PHLC) and chance health locus of control (CHLC) was administered to students. Dental plaque and gingival health status were recorded using Plaque Index (PLI) and Gingival Index (GI), 1967. Oral health education was provided using power point presentation after the baseline oral examination. After 10 weeks of intervention, the students were given the same proforma followed by the assessment of plaque and gingival status.

RESULTS

A negative correlation was observed between PHLC and IHLC with PLI and GI and positive correlation of CHLC with PLI and GI at a level of P < 0.01. The difference between 'pre-test' and 'post-test' mean PLI scores, GI scores, PHLC was found to be statistically significant at a level of P < 0.05.

CONCLUSION

Oral health education was found to be effective and this could change the behaviour of individuals.

Routine scale and polish for periodontal health in adults

BACKGROUND

Many dentists or hygienists provide scaling and polishing for patients at regular intervals, even if those patients are considered to be at low risk of developing periodontal disease. There is debate over the clinical effectiveness and cost effectiveness of 'routine scaling and polishing' and the 'optimal' frequency at which it should be provided for healthy adults.A 'routine scale and polish' treatment is defined as scaling or polishing or both of the crown and root surfaces of teeth to remove local irritational factors (plaque, calculus, debris and staining), that does not involve periodontal surgery or any form of adjunctive periodontal therapy such as the use of chemotherapeutic agents or root planing.

OBJECTIVES

The objectives were: 1) to determine the beneficial and harmful effects of routine scaling and polishing for periodontal health; 2) to determine the beneficial and harmful effects of providing routine scaling and polishing at different time intervals on periodontal health; 3) to compare the effects of routine scaling and polishing with or without oral hygiene instruction (OHI) on periodontal health; and 4) to compare the effects of routine scaling and polishing provided by a dentist or dental care professional (dental therapist or dental hygienist) on periodontal health.

SEARCH METHODS

We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 15 July 2013), CENTRAL (The Cochrane Library 2013, Issue 6), MEDLINE via OVID (1946 to 15 July 2013) and EMBASE via OVID (1980 to 15 July 2013). We searched the metaRegister of Controlled Trials and the US National Institutes of Health Clinical Trials Register (clinicaltrials.gov) for ongoing and completed studies to July 2013. There were no restrictions regarding language or date of publication.

SELECTION CRITERIA

Randomised controlled trials of routine scale and polish treatments (excluding split-mouth trials) with and without OHI in healthy dentate adults, without severe periodontitis.

DATA COLLECTION AND ANALYSIS

Two review authors screened the results of the searches against inclusion criteria, extracted data and assessed risk of bias independently and in duplicate. We calculated mean differences (MDs) (standardised mean differences (SMDs) when different scales were reported) and 95% confidence intervals (CIs) for continuous data and, where results were meta-analysed, we used a fixed-effect model as there were fewer than four studies. Study authors were contacted where possible and where deemed necessary for missing information.

MAIN RESULTS

Three studies were included in this review with 836 participants included in the analyses. All three studies are assessed as at unclear risk of bias. The numerical results are only presented here for the primary outcome gingivitis. There were no useable data presented in the studies for the outcomes of attachment change and tooth loss. No studies reported any adverse effects.- Objective 1: Scale and polish versus no scale and polish Only one trial provided data for the comparison between scale and polish versus no scale and polish. This study was conducted in general practice and compared both six-monthly and 12-monthly scale and polish treatments with no treatment. This study showed no evidence to claim or refute benefit for scale and polish treatments for the outcomes of gingivitis, calculus and plaque. The MD for six-monthly scale and polish, for the percentage of index teeth with bleeding at 24 months was -2% (95% CI -10% to 6%; P value = 0.65), with 40% of the sites in the control group with bleeding. The MD for 12-monthly scale and polish was -1% (95% CI -9% to 7%; P value = 0.82). The body of evidence was assessed as of low quality.- Objective 2: Scale and polish at different time intervals Two studies, both at unclear risk of bias, compared routine scale and polish provided at different time intervals. When comparing six with 12 months there was insufficient evidence to determine a difference for gingivitis at 24 months SMD -0.08 (95% CI -0.27 to 0.10). There were some statistically significant differences in favour of scaling and polishing provided at more frequent intervals, in particular between three and 12 months for the outcome of gingivitis at 24 months, with OHI, MD -0.14 (95% CI -0.23 to -0.05; P value = 0.003) and without OHI MD -0.21 (95% CI -0.30 to -0.12; P value < 0.001) (mean per patient measured on 0-3 scale), based on one study. There was some evidence of a reduction in calculus. This body of evidence was assessed as of low quality.- Objective 3: Scale and polish with and without OHIOne study provided data for the comparison of scale and polish treatment with and without OHI. There was a reduction in gingivitis for the 12-month scale and polish treatment when assessed at 24 months MD -0.14 (95% CI -0.22 to -0.06) in favour of including OHI. There were also significant reductions in plaque for both three and 12-month scale and polish treatments when OHI was included. The body of evidence was once again assessed as of low quality.- Objective 4: Scale and polish provided by a dentist compared with a dental care professionalNo studies were found which compared the effects of routine scaling and polishing provided by a dentist or dental care professional (dental therapist or dental hygienist) on periodontal health.

AUTHORS' CONCLUSIONS

There is insufficient evidence to determine the effects of routine scale and polish treatments. High quality trials conducted in general dental practice settings with sufficiently long follow-up periods (five years or more) are required to address the objectives of this review.

Evaluating two oral health video interventions with early head start families

Poor oral health in early childhood can have long-term consequences, and parents often are unaware of the importance of preventive measures for infants and toddlers. Children in rural, low-income families suffer disproportionately from the effects of poor oral health. Participants were 91 parents of infants and toddlers enrolled in Early Head Start (EHS) living in rural Hawai'i, USA. In this quasi-experimental design, EHS home visitors were assigned to use either a didactic or family-centered video with parents they served. Home visitors reviewed short segments of the assigned videos with parents over an eight-week period. Both groups showed significant prepost gains on knowledge and attitudes/behaviors relating to early oral health as well as self-reported changes in family oral health routines at a six-week followup. Controlling for pretest levels, parents in the family-centered video group showed larger changes in attitudes/behaviors at posttest and a higher number of positive changes in family oral health routines at followup. Results suggest that family-centered educational videos are a promising method for providing anticipatory guidance to parents regarding early childhood oral health. Furthermore, establishing partnerships between dental care, early childhood education, and maternal health systems offers a model that broadens potential reach with minimal cost.

School-based strategies for oral health education of adolescents--a cluster randomized controlled trial

Background

Oral health education (OHE) in schools has largely been imparted by dental professionals. Considering the substantial cost of this expert-led approach, the strategies relying on teachers, peer-leaders and learners themselves have also been utilized. However the evidence for comparative effectiveness of these strategies is lacking in the dental literature. The present study was conducted to compare the effectiveness of dentist-led, teacher-led, peer-led and self-learning strategies of oral health education.

Methods

A two-year cluster randomized controlled trial following a parallel design was conducted. It involved five groups of adolescents aged 10-11 years at the start of the study. The trial involved process as well as four outcome evaluations. The present paper discusses the findings of the study pertaining to the baseline and final outcome evaluation, both comprising of a self-administered questionnaire, a structured interview and clinical oral examination. The data were analyzed using Generalized Estimating Equations.

Results

All the three educator-led strategies of OHE had statistically higher mean oral health knowledge (OHK), oral health behavior (OHB), oral hygiene status (OHS) and combined knowledge, behavior and oral hygiene status (KBS) scores than the self-learning and control groups (p<0.001). The mean OHK, OHS and KBS scores of the three educator-led strategies did not differ significantly. The peer-led strategy was, however, found to have a significantly better OHB score than the respective score of the teacher-led strategy (p<0.05). The self-learning group had significantly higher OHB score than the control group (p<0.05) but the OHK, OHS and KBS scores of the two groups were not significantly different.

Conclusions

The dentist-led, teacher-led and peer-led strategies of oral health education are equally effective in improving the oral health knowledge and oral hygiene status of adolescents. The peer-led strategy, however, is almost as effective as the dentist-led strategy and comparatively more effective than the teacher-led and self-learning strategies in improving their oral health behavior.

Trail registration

SRCTN39391017

Oral and written instruction of oral hygiene: a randomized trial

BACKGROUND

This randomized, evaluator-masked, controlled study evaluates the effectiveness of oral in contrast to written instruction of oral hygiene.

METHODS

Eighty-three students without clinical signs of periodontitis were randomly assigned to either a control group or one of three experimental conditions: 1) written instruction, 2) standardized oral instruction, or 3) individualized oral instruction. Plaque and bleeding indices were assessed to analyze intervention effects on oral health and oral hygiene skills. Measurements took place at baseline and 4 weeks after intervention.

RESULTS

Groups differed significantly with respect to gingival bleeding and were tentatively significant with respect to oral hygiene skills. Participants who had received oral individualized instructions showed the best results.

CONCLUSION

A gradient of effectiveness of the instruction methods was observed with most favorable results for the individualized instruction.

Promoção da saúde: perspectivas avaliativas para a saúde bucal na atenção primária em saúde

A avaliação de ações de promoção da saúde é um desafio metodológico e estratégico para a construção de evidências que possam apoiar processos de gestão em saúde. O emprego de métodos adequados de avaliação, baseado na análise participativa de processos e contextos locais, é indispensável ao sucesso das intervenções e formulação e implementação de políticas. A Política de Promoção e Vigilância em Saúde Bucal no Brasil explicita a necessidade de aprimorar estratégias avaliativas de ações de promoção da saúde bucal desenvolvidas no contexto da atenção primária que permitam avaliar não somente seus resultados e impacto, mas também o processo político e social para alcançar os objetivos estabelecidos. Este artigo se propõe a sistematizar a literatura no campo da avaliação da efetividade de estratégias de promoção da saúde, definir um modelo teórico e propor uma matriz de descritores, explorando a base referencial da promoção da saúde e práticas com potencialidade para reduzir situações de fragilidade de grupos populacionais, combater iniquidades e incorporar a participação na gestão da saúde.

Motivational interviewing may be effective in dental setting

DATA SOURCES

Medline, PsychInfo, Cinahl, ERIC and the Cochrane Library were searched to identify relevant studies.

STUDY SELECTION

Study quality was assessed using a scheme combining the Type of Evidence Schema, the Health Gains Notation framework and the Cochrane Health Promotion and Public Health Field quality assessment screening questions for qualitative studies, quantitative studies and systematic reviews.

DATA EXTRACTION AND SYNTHESIS

A qualitative synthesis was presented.

RESULTS

Thirty-two studies were identified, nine of clinical prevention and health education, three of counselling, nine of models-based interventions and 11 of motivational interviewing. Motivational interviewing interventions were found to be the most effective method for altering health behaviours in a clinical setting.

CONCLUSIONS

There is a need to develop an effective model for chairside oral health promotion that incorporates this evidence and allows oral health professionals to focus more on the underlying social determinants of oral disease during the clinical encounter. There is potential to further develop the motivational interviewing approach within the oral health field.

Oral health knowledge and behavior among adults with diabetes

The purpose of this study was to determine levels of oral health knowledge and factors associated with adequate oral health knowledge in adults with diabetes. A convenience sample of 253 adult US residents with diabetes completed an oral health survey to assess their knowledge. Results showed that only 47% of the participants answered five or more (out of a maximum of seven) oral health knowledge items related to diabetes correctly. Participants who received oral health information related to diabetes have 2.9 times the odds of possessing adequate oral health knowledge (i.e., answered five or more items correctly) compared to participants who did not received that information controlling for education and race (OR=2.86, 95% CI 1.31-6.24, P=0.008). Given that oral health information provided by health professionals (dental and/or medical) contributes to improve oral health knowledge among adults with diabetes, health professionals should take the opportunity to educate patients with diabetes about the oral manifestations (e.g., dry mouth) and complications (e.g., periodontitis and oral candidiasis) of diabetes and to promote proper oral health behaviors.

An overview of oral health promotion in adolescents

OBJECTIVE

The aim of this study was to overview the effectiveness of different strategies used to promote oral health in adolescents.

METHODS

A search of the MEDLINE via OVID database was performed through September 2007. The studies aiming to modify oral health-related lifestyle in adolescents with experimental pre- to post-test controlled study design were targeted. Oral health-related knowledge, attitudes, oral hygiene status, gingival health, and caries status were used as outcome measures for the evaluation of changes in adolescent oral health-related behaviour.

RESULTS

All studies evaluating knowledge showed cognitive gains. Only slight or no improvement in attitude was reported. The average improvement in oral hygiene was 30-50%. A wide range 0-50% of the effects on gingival health was presented. However, the relapse in oral hygiene status towards baseline values was also observed. Only studies employing professionally applied preventive measures in conjunction with educational activities reported significantly lower caries incidence.

CONCLUSION

The limited success of the behavioural interventions and the lack of diversity in methods used do not allow identification of the best ways to promote oral health towards adolescents. Therefore, alternative approaches for oral health promotion in adolescents should be explored.

Improving oral health behavior: a social psychological approach

BACKGROUND

The authors describe social psychological research that has found consistent beneficial effects of framing health messages to be congruent with personality factors in encouraging preventive oral health behaviors.

METHODS

The authors describe several studies in which they administered health messages to young adults who did not floss and who were classified as predominantly approach-oriented or avoidance-oriented on the basis of a short personality questionnaire. They framed the messages to emphasize the benefits of dental flossing or the costs of not flossing. The authors assessed the effectiveness in terms of flossing efficacy and flossing behavior.

RESULTS

When patients received a dental health message that was congruent with their motivational orientation-approach or avoidance-they had a stronger belief that they were capable of flossing, expressed greater intentions to floss and exhibited increased flossing behavior (flossing 50 to 65 percent more often in the following week).

CONCLUSIONS

Two factors that dental practitioners should consider when delivering information are whether the patient is more approach- or avoidance-oriented and whether to frame the message in terms of gains or losses.

CLINICAL IMPLICATIONS

Practitioners can use these theory-based findings in dental practice to promote positive oral health behaviors by administering brief personality assessments to patients and by framing the message accordingly.

Longitudinal association of adolescents' sense of coherence with tooth-brushing using an integrated behaviour change model

OBJECTIVE

To determine the association between adolescents' sense of coherence (SOC) and their tooth-brushing behaviour.

METHODS

This 18-month longitudinal study involved a representative sample of 8th-graders (n = 1025) from 11 randomly selected public high schools in the Limpopo Province, South Africa. Data collected by means of a self-administered questionnaire included respondents' socio-demographic profiles, vulnerability to depression, smoking status, dental treatment attendance pattern, frequency of and motivation for tooth-brushing. Based on the responses to the question on readiness to change brushing behaviour and in line with the integrated change model, respondents were also categorized as being in the pre-contemplation, contemplation or preparation/action stages. Respondents' SOC was measured using a six-item adapted Antonovsky SOC scale. Data analysis included chi-squared analysis, t-tests and step-wise multiple logistic regression.

RESULTS

At baseline, 72.6% (n = 744) of the respondents reported that they were not consistently brushing twice daily. Of those who did not brush twice daily and were followed up on (n = 578), those living with their mother at baseline not only presented with a greater increase in their SOC over time (follow-up minus baseline), but they were also more likely to be brushing twice daily at the time of the follow-up (15.4% versus 10.6%; P = 0.04). Adding baseline intention state to a multivariate model attenuated the influence of baseline SOC to a statistically insignificant level. However, increasing within-subject SOC changes (beta = 0.16; P < 0.01), living with the mother (beta = 0.11; P < 0.05), smoking (beta = -0.14; P < 0.05), being depression vulnerable (beta = -0.23; P < 0.01) and in the preparation/action stage (beta = 0.13; P < 0.05) remained associated with the transition to twice-daily tooth-brushing.

CONCLUSIONS

In planning oral health promotion interventions, it should be considered that children's psychological predisposition and family environment might significantly influence their tooth-brushing behaviour.

Psychosocial factors and early childhood caries among low-income African-American children in Detroit

OBJECTIVES

This study sought to advance knowledge of the social determinants of oral health, by examining how several specific maternal health beliefs, behaviors, and psychosocial factors relate to young children's early childhood caries (ECC) status in a lower-income African-American population.

METHODS

Data were collected by the Detroit Dental Health Project (NIDCR grant), a population-based study of 1021 African-American families with at least one child under 6 years of age and living in 39 low-income Census tracts in Detroit, Michigan. Analyses were limited to 719 children aged 1-5 years and their biological mothers, and conducted in SUDAAN to account for the complex sampling design. Survey data included health belief scales on mothers' self-efficacy, feelings of fatalism, knowledge about appropriate bottle use and children's oral hygiene needs, brushing habits, psychosocial measures of depressive symptoms (CES-D), parenting stress, and availability of instrumental social support. The child's age, dental insurance status, dental visit history, and 1-week brushing frequency were also included in the model. Children's ECC status, based on a dental examination, was the main outcome. The dental team used the International Caries Detection and Assessment System (ICDAS) criteria for caries detection. Each child was classified as either caries-free or having ECC or severe ECC (S-ECC) based on the case definition of ECC proposed by an expert panel for research purposes with preschool-aged children.

RESULTS

The dental team followed a specific examination protocol and established reliable and consistent ratings of ECC based on the ICDAS criteria. The inter-rater reliability kappa was 0.83 overall, and the intra-rater reliability kappa was 0.74 overall. One-third of the children had ECC, and 20% had severe ECC. Age of the child and lower parenting stress scores were each positively associated with ECC, while higher education and income were protective. Maternal oral health fatalism and knowledge of children's hygiene needs were associated with ECC among preschool-aged children. ECC was higher among younger children who had past restorative care.

CONCLUSIONS

These findings call attention to the high prevalence of ECC in this population and the need to consider psychosocial as well as traditional risk factors in developing interventions to reduce oral health disparities.

Routine scale and polish for periodontal health in adults

BACKGROUND

Many dentists or hygienists provide scaling and polishing for patients at regular intervals, even if those patients are considered to be at low risk of developing periodontal disease. There is debate over the clinical effectiveness and cost effectiveness of 'routine scaling and polishing' and the 'optimal' frequency at which it should be provided.

OBJECTIVES

The main objectives were: to determine the beneficial and harmful effects of routine scaling and polishing for periodontal health; to determine the beneficial and harmful effects of providing routine scaling and polishing at different time intervals on periodontal health; to compare the effects of routine scaling and polishing provided by a dentist or professionals complementary to dentistry (PCD) (dental therapists or dental hygienists) on periodontal health.

SEARCH STRATEGY

We searched the Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. Reference lists from relevant articles were scanned and the authors of eligible studies were contacted where possible to identify trials and obtain additional information. Date of most recent searches: 5th March 2007.

SELECTION CRITERIA

Trials were selected if they met the following criteria: design - random allocation of participants; participants - anyone with an erupted permanent dentition who were judged to have received a 'routine scale and polish' (as defined in this review); interventions - 'routine scale and polish' (as defined in this review) and routine scale and polish provided at different time intervals; outcomes - tooth loss, plaque, calculus, gingivitis, bleeding and periodontal indices, changes in probing depth, attachment change, patient-centred outcomes and economic outcomes.

DATA COLLECTION AND ANALYSIS

Information regarding methods, participants, interventions, outcome measures and results were independently extracted, in duplicate, by two review authors. Authors were contacted where possible and where deemed necessary for further details regarding study design and for data clarification. A quality assessment of all included trials was carried out. The Cochrane Collaboration's statistical guidelines were followed and both standardised mean differences and mean differences were calculated as appropriate using random-effects models.

MAIN RESULTS

Nine studies were included in this review. All studies were assessed as having a high risk of bias.Two split-mouth studies provided data for the comparison between scale and polish versus no scale and polish. One study, involving patients attending a recall programme following periodontal treatment, found no statistically significant differences for plaque, gingivitis and attachment loss between experimental and control units at each time point during the 1 year trial. The other study, involving adolescents in a developing country with high existing levels of calculus who had not received any dental treatment for at least 5 years, reported statistically significant differences in calculus and gingivitis (bleeding) scores between treatment and control units at 6, 12 and 22 months (in favour of 'scale and polish units') following a single scale and polish provided at baseline to treatment units. For comparisons between routine scale and polish provided at different time intervals, there were some statistically significant differences in favour of scaling and polishing provided at more frequent intervals: 2 weeks versus 6 months, 2 weeks versus 12 months (for the outcomes plaque, gingivitis, pocket depth and attachment change); 3 months versus 12 months (for the outcomes plaque, calculus and gingivitis). There were no studies comparing the effects of scaling and polishing provided by dentists or professionals complementary to dentistry.

AUTHORS' CONCLUSIONS

The research evidence is of insufficient quality to reach any conclusions regarding the beneficial and adverse effects of routine scaling and polishing for periodontal health and regarding the effects of providing this intervention at different time intervals. High quality clinical trials are required to address the basic questions posed in this review.

From victim blaming to upstream action: tackling the social determinants of oral health inequalities

The persistent and universal nature of oral health inequalities presents a significant challenge to oral health policy makers. Inequalities in oral health mirror those in general health. The universal social gradient in both general and oral health highlights the underlying influence of psychosocial, economic, environmental and political determinants. The dominant preventive approach in dentistry, i.e. narrowly focusing on changing the behaviours of high-risk individuals, has failed to effectively reduce oral health inequalities, and may indeed have increased the oral health equity gap. A conceptual shift is needed away from this biomedical/behavioural 'downstream' approach, to one addressing the 'upstream' underlying social determinants of population oral health. Failure to change our preventive approach is a dereliction of ethical and scientific integrity. A range of complementary public health actions may be implemented at local, national and international levels to promote sustainable oral health improvements and reduce inequalities. The aim of this article is to stimulate discussion and debate on the future development of oral health improvement strategies.

Provision of mouth-care in long-term care facilities: an educational trial

OBJECTIVES

This randomized clinical trial aimed to assess the effectiveness of a pyramid-based education for improving the oral health of elders in long-term care (LTC) facilities.

METHODS

Fourteen facilities matched for size were assigned randomly to an active or control group. At baseline in each facility, care-aides in the active group participated with a full-time nurse educator in a seminar about oral health care, and had unlimited access to the educator for oral health-related advice throughout the 3-month trial. Care-aides in the control group participated in a similar seminar with a dental hygienist but they received no additional advice. The residents in the facilities at baseline and after 3 months were examined clinically to measure their oral hygiene, gingival health, masticatory potential, Body Mass Index and Malnutrition Indicator Score, and asked to report on chewing difficulties.

RESULTS

Clinical measures after 3 months were not significantly different from baseline in either group, indicating that education neither influenced the oral health nor the dental hygiene of the residents.

CONCLUSIONS

A pyramid-based educational scheme with nurses and care-aides did not improve the oral health of frail elders in this urban sample of LTC facilities.

Evaluating oral health promotion: need for quality outcome measures

Oral health promotion effectiveness reviews have identified the need to improve the quality of the evaluation of interventions. A project was undertaken to identify and assess the quality of available outcome measures. This paper describes the methodology adopted and highlights the need for further development of oral health promotion outcome measures. Initially a thorough and comprehensive search of both the published and unpublished literature was undertaken to identify potential outcome measures. A set of quality criteria was then developed and used to assess the identified measures. The search identified a total of 1202 outcome measures of which 39% (n = 466) were developed for use with schoolchildren. A high proportion of the identified measures were classified as health literacy and healthy lifestyle outcomes, appropriate for the evaluation of oral health education activities. Only 1% (n = 12) of measures identified were classified in the healthy public policy category. When reviewed against the quality criteria, 49% (n = 594) of the measures were considered satisfactory. The poorest performing measures were those classified as healthy lifestyle and health literacy measures in which only 33% (n = 72) and 41% (n = 240), respectively, were deemed to be of satisfactory quality. In conclusion, a significant number of oral health promotion evaluation outcome measures have been identified although their quality is highly variable. Very few high-quality outcome measures exist for use in the evaluation of oral health policy and environmental interventions. The lack of appropriate and high-quality outcome measures is hampering the development of oral health promotion.

Evaluating the role of dental behaviour in oral health inequalities

OBJECTIVE

The aim of this study was to describe differences in dental attendance and dental self-care behaviour between socioeconomic groups and to investigate the extent to which the socioeconomic gradient in oral health was explained by these behaviours.

METHODS

We used data from a representative sample of adults in Australia, surveyed by telephone interview and by self-complete questionnaire. The dependent variables were self-reported missing teeth and the social impact of oral conditions evaluated with the 14-item Oral Health Impact Profile (OHIP-14). Socioeconomic position was measured at the small-area level. We conducted bivariate analysis using one-way analysis of variance and 95% confidence intervals (95% CI) and adjusted for the effect of age. After adjusting for age, dental behavioural variables were entered individually into multivariate linear regression models.

RESULTS

Data were obtained for 3678 dentate adults aged 18-91 years. Missing teeth and OHIP-14 scores followed a social gradient with poorer adults experiencing poorer outcomes. Routine dental attendance and diligent dental self-care were associated with inverse monotonic gradients in missing teeth (P < 0.05) and OHIP-14 scores (P < 0.05). Although adults living in areas with the least disadvantage had a preventive dental attendance orientation, no socioeconomic pattern was found for dental self-care. In multivariate analysis, the slope of the socioeconomic gradient [beta estimate for Index of Relative Socioeconomic Disadvantage (IRSD)] in missing teeth was not significantly attenuated by either dental attendance or dental self-care. For OHIP-14 scores, the slope of the socioeconomic gradient was significantly attenuated by dental visiting, but not by dental self-care and not by the combined effect of both behaviours.

CONCLUSION

The commonly held view that the poor oral health of poor people is explained by personal neglect was not supported in this study.

An oral health education programme based on the National Curriculum

AIM

The aim of this study was to develop and evaluate a teaching programme based on the national curriculum for use in a primary school setting.

DESIGN

National Curriculum guidelines were combined with oral health education messages to draw up lesson plans for teachers to deliver. A questionnaire was used to demonstrate children's oral health knowledge prior to the teaching programme, and at 1 and 7 weeks following the programme. The study took place in inner-city, state-run primary schools in Manchester and North London, UK. The subjects were children between the ages of 7 and 8 years from Manchester (n = 58) and North London (n = 30). The main outcome measure was change in knowledge attributable to a newly developed teaching programme.

RESULTS

The children in Manchester had a higher level of knowledge prior to the teaching programme. Following the teaching programme, children in both schools showed a significant improvement in dental health knowledge (P < 0.001). Seven weeks later, the Manchester children showed no significant loss of knowledge (P < 0.001).

CONCLUSIONS

The aims of the National Curriculum were easily integrated with oral health messages. A more widely available teaching resource, such as the one described in this study, would be useful to encourage the teaching profession to take on oral health education without more costly input from dental professionals.

Caring for elderly long-term care patients: oral health-related concerns and issues

Much work is needed to resolve the many issues of prevention in the complex environment of long-term care facilities and to provide effective curative care for individuals, no matter how frail, who could benefit from comprehensive dental services.

Oral health promotion programme for older migrant adults

OBJECTIVES

This study evaluated the impact of a community-based oral health promotion programme on the use of oral health services, oral health knowledge, attitudes, and practices of older Greek and Italian adults attending community clubs and living in Melbourne, Australia.

METHODS

The oral health promotion intervention consisted of three components: a series of oral health seminars, held at the clubs in the participants' native languages, the provision of oral health care products, and the production of oral health information sheets. The intervention programme was known as the Oral Health Information Seminars/Sheets (ORHIS). The content of each session was determined following suggestions and findings from the data collected. A pre-test-post-test non-equivalent control group quasi-experimental design was chosen to evaluate the intervention. A total of 520 independent-living older adults, members of Greek or Italian social clubs participated in this evaluation.

RESULTS

Participants who took part in the intervention responded with higher levels of achievement than those in the control groups. After controlling for baseline variables, experimental groups were significantly more likely than the control groups at post-test to have improved oral health attitudes, oral health knowledge, and self-assessed physical health status, as well as, self-reported oral hygiene practices and use of oral health services.

DISCUSSION

The ORHIS approach was successful within the setting of social clubs, and highly acceptable to these communities. As such, it represents a helpful approach for the design of (oral) health interventions in older adults. Further research is required to test the long-tem impact including the economic evaluation of the ORHIS approach.

Routine scale and polish for periodontal health in adults

BACKGROUND

Many dentists or hygienists provide scaling and polishing for patients at regular intervals, even if those patients are considered to be at low risk of developing periodontal disease. There is debate over the clinical effectiveness and cost effectiveness of 'routine scaling and polishing' and the 'optimal' frequency at which it should be provided.

OBJECTIVES

The main objectives were: to determine the beneficial and harmful effects of routine scaling and polishing for periodontal health; to determine the beneficial and harmful effects of providing routine scaling and polishing at different time intervals on periodontal health; to compare the effects of routine scaling and polishing provided by a dentist or professionals complementary to dentistry (PCD) (dental therapist or dental hygienist) on periodontal health.

SEARCH STRATEGY

We searched the Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. Reference lists from relevant articles were scanned and the authors of eligible studies were contacted where possible to identify trials and obtain additional information. Date of most recent searches: 9th April 2003.

SELECTION CRITERIA

Trials were selected if they met the following criteria: design - random allocation of participants; participants - anyone with an erupted permanent dentition who were judged to have received a 'routine scale and polish' (as defined in this review); interventions - 'routine scale and polish' (as defined in this review) and routine scale and polish provided at different time intervals ; outcomes- tooth loss, plaque, calculus, gingivitis, bleeding and periodontal indices, changes in probing depth, attachment change, patient-centred outcomes and economic outcomes.

DATA COLLECTION AND ANALYSIS

Information regarding methods, participants, interventions, outcome measures and results were independently extracted, in duplicate, by two reviewers. Authors were contacted where possible and where deemed necessary for further details regarding study design and for data clarification. A quality assessment of all included trials was carried out. The Cochrane Collaboration's statistical guidelines were followed and both standardised mean differences and weighted mean differences were calculated as appropriate using random-effects models.

MAIN RESULTS

Eight studies were included in this review and all studies were assessed as having a high risk of bias. Two split-mouth studies provided data for the comparison between scale and polish versus no scale and polish. One study, involving patients attending a recall programme following periodontal treatment, found no statistically significant differences for plaque, gingivitis and attachment loss between experimental and control units at each time point during the 1 year trial. The other study, involving adolescents in a developing country with high existing levels of calculus who had not received any dental treatment for at least 5 years, reported statistically significant differences in calculus and gingivitis (bleeding) scores between treatment and control units at 6, 12 and 22 months (in favour of 'scale and polish units') following a single scale and polish provided at baseline to treatment units. For comparisons between routine scale and polish provided at different time intervals, there were some statistically significant differences in favour of scaling and polishing provided at more frequent intervals: 2 weeks versus 6 months, 2 weeks versus 12 months (for the outcomes plaque, gingivitis, pocket depth and attachment change); 3 months versus 12 months (for the outcomes plaque, calculus and gingivitis). There were no studies comparing the effects of scaling and polishing provided by dentists or Professionals Complementary to Dentistry.

AUTHORS' CONCLUSIONS

The research evidence is of insufficient quality to reach any conclusions regarding the beneficial and adverse effects of routine scaling and polishing for periodontal health and regarding the effects of providing this intervention at different time intervals. High quality clinical trials are required to address the basic questions posed in this review.