Barriers to adopting and implementing an oral health programme for managing early childhood caries through primary health care providers in Lima, Peru

Factors perceived by health professionals to be barriers or facilitators to caries prevention in children: a systematic review

BACKGROUND

Considered the most prevalent noncommunicable disease in childhood, dental caries is both an individual and a collective burden. While international guidelines highlight prevention as a major strategy for caries management in children, health professionals still struggle to implement prevention into their clinical practice. Further research is needed to understand the gap between the theoretical significance of dental prevention and its lack of implementation in the clinical setting. This systematic review aims to identify and classify factors perceived by health professionals to be barriers or facilitators to caries prevention in children.

METHOD

A systematic literature search was conducted in three electronic databases (Medline, Web of Science and Cairn). Two researchers independently screened titles, abstracts and texts. To be selected, studies had to focus on barriers or facilitators to caries prevention in children and include health professionals as study participants. Qualitative and quantitative studies were selected. The factors influencing caries prevention in children were sorted into 3 main categories (clinician-related factors, patient-related factors, and organizational-related factors) and then classified according to the 14 domains of the theoretical domains framework (TDF).

RESULTS

A total of 1771 references were found by combining manual and database searches. Among them, 26 studies met the inclusion criteria, of which half were qualitative and half were quantitative studies. Dentists (n = 12), pediatricians (n = 11), nurses (n = 9), and physicians (n = 5) were the most frequently interviewed health professionals in our analysis. Barriers and facilitators to caries prevention in children were categorized into 12 TDF domains. The most frequently reported domains were Environmental Context and Resources, Knowledge and Professional Role and Identity.

CONCLUSION

This systematic review found that a wide range of factors influence caries prevention in children. Our analysis showed that barriers to pediatric oral health promotion affect all stages of the health care system. By highlighting the incompatibility between the health care system's organization and the implementation of caries prevention, this study aims to help researchers and policy-makers design new interventions to improve children's access to caries prevention.

TRIAL REGISTRATION

PROSPERO CRD42022304545.

Increasing the Awareness of Pediatric Nurses about the Protection and Continuity of the Oral and Dental Health of Children

Objectives: To provide pediatric nurses with knowledge and skills on oral and dental health and to increase their awareness. Material and Methods: In the first phase of the study, pre-tests were given to pediatric nurses in Trabzon and Rize central and district hospitals. A Whatsapp group was created with the nurses who completed the tests, and the training video prepared by the researcher was shared. In the second phase of the study, the same questions were applied again as the post-test. Jamovi (Version 1.0.4) software was used for statistical analysis. P < 0.05 was accepted as statistically significant in all analyses. Results: Of the 91 nurses who completed both the pre-test and the post-test, 83 (91.2%) were female and 8 (8.8%) were male. In all sections in the test category consisting of six different sections (Tooth Decay, Risk Factors in Dental Caries, Prevention of Dental Caries, Oral and Dental Injuries, Children with Special Care Needs, What to Do - How to do?), the success rate was significantly higher in the post-test ( p < 0.001). Conclusion: Research emphasizes that neonatal nurses, pediatric nurses and health professionals working in community health centers should be activated and empowered in order to prevent oral and dental health problems of children, and awareness should be increased with scientifically valid educational guidelines. The results of the present study support these views and emphasize the importance of education by showing significant improvement with the training provided to nurses who had insufficient knowledge and awareness about the subject. Amaç: Pediatri hemşirelerine ağız ve diş sağlığı konusundaki bilgi ve beceriyi kazandırmak ve onların farkındalıklarını artırmaktır. Gereç ve Yöntemler: Araştırmanın birinci aşamasında, Trabzon ve Rize merkez ve ilçe hastanelerindeki pediatri servis hemşirelerine ön test soruları verildi. Testi cevaplayan hemşirelerle oluşturulan Whatsapp grubunda, tarafımca hazırlanan eğitim videosu paylaşıldı. İkinci aşamada; ön test sorularının aynısı, son test olarak tekrar uygulandı. İstatistiksel analiz için Jamovi (Sürüm 1.0.4) yazılımı kullanıldı. İstatistiksel anlamlılık için olasılık seviyesi p = 0,05 olarak belirlendi. Bulgular: Hem ön test hem de son testi cevaplayan 91 hemşirenin 83’ ü (91.2%) kadın, 8’i (8.8%) erkekti. Altı farklı bölümden oluşan test kategorisindeki tüm bölümlerde ( Diş Çürüğü, Diş Çürüklerinde Risk Faktörleri, Diş Çürüğünün Önlenmesi, Ağız ve Diş Yaralanmaları, Özel Bakım İhtiyacı Olan Çocuklar, Ne Yapmalı - Nasıl Yapılır?) eğitim sonrası yapılan son testteki başarı oranı anlamlı ölçüde artmıştı (p

Reducing carious lesions during the first 4 years of life: An interprofessional approach

BACKGROUND

Caries in Peruvian 0- through 3-year-olds is high. The dental profession should collaborate with nurses at mother and child health (MCH) clinics for reducing the disease. In this randomized clinical trial, the authors tested an integrated intervention program implemented by nurses and dentists.

METHODS

The authors developed age-specific (0-3 years) oral health-related information and activity record cards and validated them for nurses to use after being educated about oral health issues and mouth inspection. The authors trained dentists in atraumatic restorative treatment. The active intervention group (AG) participated in the integrated intervention program, the passive intervention group (PG) received only the oral health-related information and activity record cards, and the control group (CG) received only a lecture. The examiners assessed caries status according to the Caries Assessment Spectrum and Treatment instrument. The authors used analysis of variance and the Tamhane method to analyze the data.

RESULTS

The sample consisted of 368 children with a mean age of 3.1 years. The 3-year dropout percentage was 40.5%. The prevalence of cavitated dentin carious lesions was statistically significantly lower in the AG (10.0%, confidence interval [CI] 4.1 to 19.5) than in the PG (60.5%, CI 48.6 to 71.5) and CG (63.0%, CI 50.9 to 74.0) after 3 years (P < .001). Enamel carious lesions (62.9%) were most prevalent in the AG, whereas carious lesions were most prevalent in the PG (28.9%) and CG (32.9%).

CONCLUSIONS

Incorporation of specific oral health care activities into the existing MCH program, implemented by trained nurses and supported by health center dentists, reduced the burden of caries in 3-year-olds substantially.

PRACTICAL IMPLICATIONS

The oral health care professionals in Peru should collaborate with personnel of MCH clinics to curb caries in 0- through 3-year-olds.

Barriers and facilitators in the integration of oral health into primary care: a scoping review

OBJECTIVE

This scoping study has been conducted to map the literature and provide a descriptive synthesis on the barriers and facilitators of the integration of oral health into primary care.

METHODS

Grounded in the Rainbow conceptual model and using the Levac et al six-stage framework, we performed a systematic search of electronic databases, organisational websites and grey literature from 1978 to April 2016. All publications with a focus on the integration of oral health into primary care were included except commentaries and editorials. Thematic analyses were performed to synthesise the results.

RESULTS

From a total of 1619 citations, 58 publications were included in the review. Barrier-related themes included: lack of political leadership and healthcare policies; implementation challenges; discipline-oriented education; lack of continuity of care and services and patients' oral healthcare needs. The facilitators of integration were supportive policies and resources allocation, interdisciplinary education, collaborative practices between dental and other healthcare professionals, presence of local strategic leaders and geographical proximity.

DISCUSSION AND PUBLIC HEALTH IMPLICATIONS

This work has advanced the knowledge on the barriers and facilitators at each integration domain and level, which may be helpful if the healthcare organisations decide to integrate oral health and dental services into primary care. The scoping review findings could be useful for both dental and medical workforce and allied primary healthcare providers. They could also guide the development of healthcare policies that support collaborative practices and patient-centred care in the field of primary care.