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Gomersall JC, Slack-Smith L, Kilpatrick N, Muthu MS, Riggs E. Interventions with pregnant women, new mothers and other primary caregivers for preventing early childhood caries. Cochrane Database Syst Rev 2024; 5:CD012155. [PMID: 38753314 PMCID: PMC11098061 DOI: 10.1002/14651858.cd012155.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
BACKGROUND Dental caries, a common chronic disease of childhood, is associated with adverse health and economic consequences for infants and their families. Socioeconomically disadvantaged children have a higher risk of early childhood caries (ECC). This review updates one published in 2019. OBJECTIVES To assess the effects of interventions undertaken with pregnant women, new mothers or other primary caregivers of infants in the first year of life, for preventing ECC (from birth to six years). SEARCH METHODS We searched Cochrane Oral Health's Trials Register, Cochrane Pregnancy and Childbirth's Trials Register, CENTRAL, MEDLINE (Ovid), Embase (Ovid), CINAHL EBSCO, the US National Institutes of Health Ongoing Trials Register (clinicaltrials.gov) and WHO International Clinical Trials Registry Platform (apps.who.int/trialsearch). The latest searches were run on 3 January, 2023. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing interventions with pregnant women, or new mothers and other primary caregivers of infants in the first year of life, against standard care, placebo or another intervention, reporting on a primary outcome: caries presence in primary teeth, dmfs (decayed, missing, filled primary surfaces index), or dmft (decayed, missing, filled teeth index), in children up to six years of age. Intervention types include clinical, oral health promotion/education (hygiene education, breastfeeding and other dietary advice) and policy or service. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study eligibility, extracted data, assessed risk of bias, and assessed certainty of evidence (GRADE). MAIN RESULTS We included 23 RCTs (5 cluster-randomised), involving 25,953 caregivers (mainly mothers) and their children. Fifteen trials assessed oral health education/promotion interventions against standard care. Six trials assessed a clinical intervention for mother dentition, against placebo, or a different type of clinical intervention. Two trials assessed oral health/education promotion plus clinical intervention (for mother's dentition) against standard care. At most, five trials (maximum of 1326 children and 130 mothers) contributed data to any comparison. Enamel-only caries were included in the diagnosis of caries in some studies. For many trials, the risk of bias was unclear due to lack of methodological details reported. In thirteen trials, participants were socioeconomically disadvantaged. No trial indicated receiving funding that was likely to have influenced their results. Oral health education/promotion interventions Child diet and feeding practice advice versus standard care: We observed a probable 15 per cent reduced risk of caries presence in primary teeth with the intervention (RR 0.85, 95% CI 0.75 to 0.97; 3 trials; 782 participants; moderate-certainty evidence), and there may be a slightly lower mean dmfs (MD -0.29, 95% CI -0.58 to 0; 2 trials; 757 participants; low-certainty evidence); however, the evidence is very uncertain regarding the difference between groups in mean dmft (MD -0.90, 95% CI -1.85 to 0.05; 1 trial; 340 participants; very low-certainty evidence). Breastfeeding promotion and support versus standard care: We observed little or no difference between groups in the risk of caries presence in primary teeth (RR 0.96, 95% CI 0.89 to 1.03; 2 trials; 1148 participants; low-certainty evidence) and in mean dmft (MD -0.12, 95% CI -0.59 to 0.36; 2 trials; 652 participants; low-certainty evidence). dmfs was not reported. Child diet advice compared with standard care: We are very uncertain about the effect on the risk of caries presence in primary teeth (RR 1.08, 95% CI 0.34 to 3.37; 1 trial; 148 participants; very low-certainty evidence). dmfs and dmft were not reported. Oral hygiene, child diet and feeding practice advice versus standard care: The evidence is very uncertain about the effect on the risk of caries presence in primary teeth (RR 0.73, 95% CI 0.50 to 1.07; 5 trials; 1326 participants; very low-certainty evidence) and there maybe little to no difference in mean dmfs (MD -0.87, 95% CI -2.18 to 0.43; 2 trials; 657 participants; low-certainty evidence) and mean dmft (MD -0.30, 95% CI -0.96 to 0.36; 1 trial; 187 participants; low-certainty evidence). High-dose versus low-dose vitamin D supplementation during pregnancy: We are very uncertain about the effect on risk of caries presence in primary teeth (RR 0.99, 95% CI 0.70 to 1.41; 1 trial; 496 participants; very low-certainty evidence). dmfs and dmft were not reported. Clinical interventions (for mother dentition) Chlorhexidine (CHX, a commonly prescribed antiseptic agent) or iodine-NaF application and prophylaxis versus placebo: We are very uncertain regarding the difference in risk of caries presence in primary teeth between antimicrobial and placebo treatment for mother dentition (RR 0.97, 95% CI 0.80 to 1.19; 3 trials; 479 participants; very low-certainty evidence). No trial reported dmfs or dmft. Xylitol compared with CHX antimicrobial treatment: We are very uncertain about the effect on caries presence in primary teeth (RR 0.62, 95% CI 0.27 to 1.39; 1 trial, 96 participants; very low-certainty evidence), but we observed there may be a lower mean dmft with xylitol (MD -2.39; 95% CI -4.10 to -0.68; 1 trial, 113 participants; low-certainty evidence). No trial reported dmfs. Oral health education/promotion plus clinical interventions (for mother dentition) Diet and feeding practice advice for infants and young children plus basic dental care for mothers compared with standard care: We are very uncertain about the effect on risk of caries presence in primary teeth (RR 0.44, 95% CI 0.05 to 3.95; 2 trials, 324 participants; very low-certainty evidence) or on mean dmft (1 study, not estimable). No trial reported dmfs. No trials evaluated policy or health service interventions. AUTHORS' CONCLUSIONS There is moderate-certainty evidence that providing advice on diet and feeding to pregnant women, mothers or other caregivers with children up to the age of one year probably leads to a slightly reduced risk of early childhood caries (ECC). The remaining evidence is low to very-low certainty and is insufficient for determining which, if any, other intervention types and features may be effective for preventing ECC, and in which settings. Large, high-quality RCTs of oral health education/promotion, clinical, and policy and service access interventions, are warranted to determine the effects and relative effects of different interventions and inform practice. We have identified 13 ongoing studies. Future studies should consider if and how effects are modified by intervention features and participant characteristics (including socioeconomic status).
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Affiliation(s)
- Judith C Gomersall
- Life Course and Intergenerational Health Research Group, Robinson Research Institute and School of Public Health, The University of Adelaide, Adelaide, Australia
| | - Linda Slack-Smith
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Nicky Kilpatrick
- Vascular Biology, Murdoch Children's Research Institute, Melbourne, Australia
- Plastic and Maxillofacial Surgery, Royal Children's Hospital, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Carlton, Australia
| | - M S Muthu
- Centre for Early Childhood Caries Research, Department of Pediatric and Preventive Dentistry, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
| | - Elisha Riggs
- Intergenerational Health, Murdoch Children's Research Institute, Parkville, Australia
- Department of General Practice, The University of Melbourne, Melbourne, Australia
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Cagetti MG, Salerno C, Ionescu AC, La Rocca S, Camoni N, Cirio S, Campus G. Knowledge and attitudes on oral health of women during pregnancy and their children: an online survey. BMC Oral Health 2024; 24:85. [PMID: 38229165 DOI: 10.1186/s12903-023-03732-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/01/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Life-long healthy behaviors are established during pregnancy and the first years of life. In this cross-sectional survey, new mothers with a high level of schooling living in Northern Italy (Lombardy Region) were interviewed to assess their knowledge and attitudes towards their and child oral health. METHODS A questionnaire (27 items) was developed to assess socio-demographic factors, knowledge, and attitudes towards maternal and child oral health. The questionnaire was disseminated in perinatal courses, private gynecological clinics, and via social media. Mothers aged ≥18 years, with at least a child aged 0-36 months, with a high school diploma or higher, were included in the survey. RESULTS A total of 1340 women completed the questionnaire, 1297 of whom had a child aged 0-36 months, 792 lived in Lombardy, and 600 had a high level of education and were finally included. About half of the sample (44.67%) was aged between 31 and 35 years, 76.50% were employed, and the majority had only one child (81.50%). During pregnancy, 28.33% of the sample reported problems with teeth and gums, while only 36.00% visited a dentist. More than 40% of the sample said they were not aware of a possible link between oral health and pregnancy, and 73.17% had not received any advice about their oral health or the future health of their baby's mouth. Less than 20% of women were aware of the increased caries risk associated with prolonged or night-time breastfeeding. Better knowledge/attitude was associated with the age of the child (p < 0.05), the number of children (p < 0.05) and whether the mother had received advice during pregnancy (p < 0.05). CONCLUSIONS The results of this survey show a lack of dental care during pregnancy, a lack of information about oral health from health professionals during and after pregnancy, and consequently gaps in the knowledge needed to care for the oral health of the woman and her child. There is a need for training in oral health for pregnant women and new mothers, but also a need for behavioural change among health professionals who care for pregnant women.
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Affiliation(s)
- Maria Grazia Cagetti
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via Beldiletto 1, 20142, Milan, Milan, Italy
| | - Claudia Salerno
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Freiburgstrasse 7, 3012, Bern, Switzerland.
| | - Andrei Cristian Ionescu
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via Pascal 36, 20133, Milan, Milan, Italy
| | - Serena La Rocca
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via Beldiletto 1, 20142, Milan, Milan, Italy
| | - Nicole Camoni
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via Beldiletto 1, 20142, Milan, Milan, Italy
| | - Silvia Cirio
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via Beldiletto 1, 20142, Milan, Milan, Italy
| | - Guglielmo Campus
- Department of Surgery, Microsurgery and Medicine Sciences - School of Dentistry University of Sassari, Sassari, Italy. Viale San Pietro, 43. Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Freiburgstrasse 7, 3012, Bern, Switzerland
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Bashirian S, Barati M, Barati M, Shirahmadi S, Khazaei S, Jenabi E, Gholami L. Promoting Oral Health Behavior During Pregnancy: A Randomized Controlled Trial. J Res Health Sci 2023; 23:e00584. [PMID: 37571955 PMCID: PMC10422136 DOI: 10.34172/jrhs.2023.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/27/2023] [Accepted: 06/18/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Pregnant women are vulnerable to oral disease due to physiological, hormonal, and dietary alterations. The aim of the present study was to evaluate the impact of the educational program according to the Health Promotion Model (HPM) on the oral health prevention behavior of pregnant women. STUDY DESIGN A randomized controlled trial. METHODS This study was performed on 105 pregnant women visiting health centers located in Arak from February to November 2022. The subjects were randomly assigned to intervention (n=54) and control (n=51) groups. A reliable and valid questionnaire according to HPM constructs was used to collect the data. The pre-test was conducted in the groups. The intervention group received the educational program in 9 educational sessions (from 12 to 24 weeks of pregnancy). Then, the post-test was conducted in the 36th week of pregnancy in the groups. Finally, the data were analyzed by SPSS software (version 18) and using independent t-test, paired t-test, and Chi-square test. RESULTS There were statistically significant differences between the intervention and control groups regarding perceived benefits (24.68±3.63 vs. 26.57±3.67, P=0.009), perceived barriers (7.31±3.14 vs. 5.81±3.59, P=0.025), positive affect (10.50±1.66 vs. 11.29±1.34, P=0.009), negative affect (1.59±0.223 vs. 1.40±1.51, P=0.006), commitment to the action plan (4.05±1.92 vs. 4.77±1.50, P=0.034), and tooth brushing time (2.29±0.72 vs. 2.74±0.48, P<0.001). However, no significant difference was observed regarding the tooth brushing frequency (2.05±0.58 vs. 2.07±0.66, P=0.901) after the intervention. The brushing time for 2-3 minutes in the intervention group increased from 51.85% to 75.92% after the intervention. CONCLUSION HPM-based education was effective in promoting the duration of tooth brushing in pregnant women. However, it had no effect on the tooth brushing frequency.
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Affiliation(s)
- Saeid Bashirian
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Department of Public Health, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Maryam Barati
- Department of Public Health, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Majid Barati
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Department of Public Health, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Samane Shirahmadi
- Department of Community Oral Health, School of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Salman Khazaei
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ensiyeh Jenabi
- Autism Spectrum Disorders Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Leila Gholami
- Department of Periodontology, School of Dentistry, Hamedan Medical Science University, Hamedan, Iran
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George A, Kong A, Sousa MS, Villarosa A, Ajwani S, Dahlen HG, Bhole S, Yaacoub A, Srinivas R, Johnson M. Long-term effectiveness of the midwifery initiated oral health-dental service program on maternal oral health knowledge, preventative dental behaviours and the oral health status of children in Australia. Acta Odontol Scand 2023; 81:164-175. [PMID: 36001600 DOI: 10.1080/00016357.2022.2108896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The Midwifery Initiated Oral Health-Dental Service was developed to train midwives to promote maternal oral health, and a large trial showed it substantially improved the oral health, knowledge and behaviours of pregnant women. AIM Evaluate the long-term effectiveness of the program (post-trial) on maternal oral health knowledge, dental behaviours, and early childhood caries in offspring. METHODS A prospective cohort study involving 204 women and children 3-4 years (followed after trial) was conducted in Sydney, Australia from 2017 to 2019. RESULTS The program did not have a significant impact on the study measures. Mothers who received the program did have comparatively better knowledge around preventative behaviours to reduce early childhood caries and significantly more mothers were engaging in a key behaviour of using a cup to feed their child. Overall maternal oral health knowledge and level of education did have a protective effect on the dental decay of children. Higher knowledge and levels of education reduced the odds of having a dmft of one or more by over half (OR 0.473), and almost 80% (OR 0.212) respectively. CONCLUSIONS Although the MIOH-DS program was not effective, there is still value in exploring other complementary interventions to improve maternal oral health, especially for disadvantaged families. Future research should focus on co-designing an antenatal and postnatal oral health intervention and exploring its long-term impact on the oral health of children.
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Affiliation(s)
- Ajesh George
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, Australia.,Ingham Institute for Applied Medical Research, Liverpool, Australia.,School of Dentistry, Faculty of Medicine and Health, University of Sydney, Surry Hills, Australia.,La Trobe Rural Health School, La Trobe University, Bendigo, Australia.,Translational Health Research Institute, Western Sydney University, Campbelltown, Australia
| | - Ariana Kong
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, Australia.,Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Mariana S Sousa
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, Australia.,Ingham Institute for Applied Medical Research, Liverpool, Australia.,IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Broadway, Australia
| | - Amy Villarosa
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, Australia.,Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Shilpi Ajwani
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, Australia.,School of Dentistry, Faculty of Medicine and Health, University of Sydney, Surry Hills, Australia.,Sydney Dental Hospital, Oral Health Services, Sydney Local Health District, Surry Hills, Australia.,Sydney Institute for Women, Children and Families, Sydney Local Health District, Surry Hills, Australia
| | - Hannah G Dahlen
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, Australia.,Translational Health Research Institute, Western Sydney University, Campbelltown, Australia
| | - Sameer Bhole
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, Australia.,School of Dentistry, Faculty of Medicine and Health, University of Sydney, Surry Hills, Australia.,Sydney Dental Hospital, Oral Health Services, Sydney Local Health District, Surry Hills, Australia.,Sydney Institute for Women, Children and Families, Sydney Local Health District, Surry Hills, Australia
| | - Albert Yaacoub
- School of Dentistry, Faculty of Medicine and Health, University of Sydney, Surry Hills, Australia.,Oral Health Services, Nepean Blue Mountains Local Health District, Kingswood, Australia
| | - Ravi Srinivas
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, Australia.,Ingham Institute for Applied Medical Research, Liverpool, Australia.,School of Dentistry, Faculty of Medicine and Health, University of Sydney, Surry Hills, Australia.,Oral Health Services, South Western Sydney Local Health District, Liverpool, Australia
| | - Maree Johnson
- Faculty of Health Sciences, Australian Catholic University, North Sydney, Australia
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Tuncer E, Darby I. Knowledge and attitudes towards periodontal health among Australians diagnosed with diabetes. Aust J Prim Health 2021; 27:509-513. [PMID: 34823646 DOI: 10.1071/py20311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/08/2021] [Indexed: 12/20/2022]
Abstract
Diabetes and periodontitis are two major diseases affecting the Australian population. Despite the established interrelationship between the diseases, the knowledge of people with diabetes about this interrelationship is limited. This study investigated the knowledge of individuals with diabetes towards periodontal health in Australia. Adults diagnosed with diabetes participated in a survey asking about demographics, medical history, symptoms in the oral cavity, oral hygiene, attendance at the dentist and their knowledge of the interactions between periodontal disease and diabetes. The survey was completed by 113 participants, most of whom thought their diabetes was well controlled. Over half reported bleeding on brushing and one-third reported swollen gums. More than half (53.6%) the respondents were unaware of any complications of diabetes associated with the oral cavity, especially periodontal disease. Most respondents did not talk to their dentist about diabetes (53.6%), yet most wanted to know more about the effects of diabetes on gum health (75.3%). These findings demonstrate that, in this survey, adult Australians diagnosed with diabetes have limited knowledge about how periodontal disease affects them. These individuals, who are at a higher risk of periodontal disease, need to be better informed of the established bidirectional relationship between diabetes and oral health by all health professionals.
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Affiliation(s)
- Eren Tuncer
- Melbourne Dental School, The University of Melbourne, 720 Swanston Street, Carlton, Vic. 3053, Australia
| | - Ivan Darby
- Melbourne Dental School, The University of Melbourne, 720 Swanston Street, Carlton, Vic. 3053, Australia; and Corresponding author.
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Gao Y, Ju X, Jamieson L. Associations between dental care approachability and dental attendance among women pregnant with an Indigenous child: a cross-sectional study. BMC Oral Health 2021; 21:451. [PMID: 34535100 PMCID: PMC8446472 DOI: 10.1186/s12903-021-01816-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 09/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background Oral health during pregnancy is vital for both mother and child. Indigenous Australians face many barriers in accessing dental care. Service approachability is one of the key domains in accessing health services. There is little empirical evidence of the association between service approachability and dental care attendance or oral health outcome. The aim of this study is to examine the relationship between dental service approachability on dental care attendance and self-reported gum disease among South Australian women pregnant with an Aboriginal child. Methods Four hundred and twenty-seven women pregnant with an Aboriginal child completed questionnaires in both metropolitan and regional health settings in South Australia in 2011. Four variables related to approachability of dental services: (1) perception of need; (2) service-related health literacy; (3) oral health beliefs and; (4) trust and expectation of dental service. The association between service approachability-related factors, dental utilisation and self-reported gum disease during pregnancy were assessed using Generalised Poisson regression models, after adjusting for age, remoteness, employment status and education. Estimates were presented as adjusted prevalence ratios (APR). Results Most participants (85.8%) reported a need for dental care, had positive oral health beliefs (88.3%) and had expectations towards dental care (86.2%). Dental service utilisation during pregnancy was low (35.7%). Many participants (78.0%) expressed knowing what to do if they needed dental care, while most (39.8%) doubted that dental care would be available the next day. Poor health service literacy was identified as a risk factor for non-optimal dental attendance (APR = 0.86, 95%CI 0.74–0.99). Perceived need for dental care was positively associated with self-reported gum disease (APR = 1.24, 95%CI 1.06–1.45). Conclusion Inability to navigate the dental care system was a risk factor for poor dental attendance among South Australian women pregnant with an Aboriginal child. Perceived need for dental care was associated with gum disease. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-021-01816-5.
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Affiliation(s)
- Yuan Gao
- School of Public Health, The University of Adelaide, Adelaide, Australia
| | - Xiangqun Ju
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, Australia.
| | - Lisa Jamieson
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, Australia
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Tannous KW, George A, Ahmed MU, Blinkhorn A, Dahlen HG, Skinner J, Ajwani S, Bhole S, Yaacoub A, Srinivas R, Johnson M. Economic evaluation of the Midwifery Initiated Oral Health-Dental Service programme in Australia. BMJ Open 2021; 11:e047072. [PMID: 34341045 PMCID: PMC8330572 DOI: 10.1136/bmjopen-2020-047072] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 07/19/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To critically evaluate the cost-effectiveness of the Midwifery Initiated Oral Health-Dental Service (MIOH-DS) designed to improve oral health of pregnant Australian women. Previous efficacy and process evaluations of MIOH-DS showed positive outcomes and improvements across various measures. DESIGN AND SETTING The evaluation used a cost-utility model based on the initial study design of the MIOH-DS trial in Sydney, Australia from the perspective of public healthcare provider for a duration of 3 months to 4 years. PARTICIPANTS Data were sourced from pregnant women (n=638), midwives (n=17) and dentists (n=3) involved in the MIOH trial and long-term follow-up. COST MEASURES Data included in analysis were the cost of the time required by midwives and dentists to deliver the intervention and the cost of dental treatment provided. Costs were measured using data on utilisation and unit price of intervention components and obtained from a micro-costing approach. OUTCOME MEASURES Utility was measured as the number of Disability Adjusted Life Years (DALYs) from health-benefit components of the intervention. Three cost-effectiveness analyses were undertaken using different comparators, thresholds and time scenarios. RESULTS Compared with current practice, midwives only intervention meets the Australian threshold (A$50 000) of being cost-effective. The midwives and accessible/affordable dentists joint intervention was only 'cost-effective' in 6 months or beyond scenarios. When the midwife only intervention is the comparator, the midwife/dentist programme was 'cost-effective' in all scenarios except at 3 months scenario. CONCLUSIONS The midwives' only intervention providing oral health education, assessment and referral to existing dental services was cost-effective, and represents a low cost intervention. Midwives' and dentists' combined interventions were cost-effective when the benefits were considered over longer periods. The findings highlight short and long term economic benefits of the programme and support the need for policymakers to consider adding an oral health component into antenatal care Australia wide. TRIAL REGISTRATION NUMBER ACTRN12612001271897; Post-results.
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Affiliation(s)
- Kathy W Tannous
- Translational Health Research Institute, Digital Health Cooperative Research Centre, Economics, Finance and Property, School of Business, Western Sydney University, Penrith, New South Wales, Australia
| | - Ajesh George
- Centre for Oral Health Outcomes & Research Translation (COHORT), Western Sydney University, South Western Sydney Local Health District, Ingham Institute Applied Medical Research, Liverpool, New South Wales, Australia
- School of Dentistry, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Moin Uddin Ahmed
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Anthony Blinkhorn
- School of Dentistry, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Hannah G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - John Skinner
- Poche Centre for Indigenous Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Shilpi Ajwani
- School of Dentistry, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
- Oral Health Services and Sydney Dental Hospital, Sydney Local Health District, Surry Hills, New South Wales, Australia
| | - Sameer Bhole
- School of Dentistry, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
- Oral Health Services and Sydney Dental Hospital, Sydney Local Health District, Surry Hills, New South Wales, Australia
| | - Albert Yaacoub
- Oral Health Services, Nepean Blue Mountains Local Health District, Penrith, New South Wales, Australia
| | - Ravi Srinivas
- Centre for Oral Health Outcomes & Research Translation (COHORT), Western Sydney University, South Western Sydney Local Health District, Ingham Institute Applied Medical Research, Liverpool, New South Wales, Australia
- School of Dentistry, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
- Oral Health Services, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Maree Johnson
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- Australian Catholic University, North Sydney, New South Wales, Australia
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McGrath R, Marino R, Satur J. Oral health promotion practices of Australian community mental health professionals: a cross sectional web-based survey. BMC Oral Health 2021; 21:85. [PMID: 33632192 PMCID: PMC7908706 DOI: 10.1186/s12903-021-01438-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 02/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study explored the oral health promotion practices of Australian community mental health professionals working with people living with severe mental illness (SMI). METHODS An anonymous cross-sectional web-based survey was distributed to all Community Rehabilitation and Support Workers (CRSWs) working at Neami National (n = 471), an Australian community mental health service. The validated questionnaire assessed participants' self-rated oral health knowledge and confidence (7 questions); their perceived barriers (9 questions) and attitudes (5 questions) to oral health promotion; and their oral health promotion practices (7 questions). Differences in responses between groups were analysed using Chi-square, Fisher's exact and Mann-Whitney U tests. Logistic Regression Analysis served to explore the probability of providing oral health support to mental health consumers. RESULTS A total of 141 CRSWs were included in this study, achieving a response rate of 30 percent. Roughly two-fifths (39.0%) of participants had oral health training in the previous 12-months. The majority of CRSWs (89.3%) believed ('Agreed' or 'Strongly agreed') that mental health support workers have a role to play in promoting oral health. However, less than half (44.0%) of CRSWs practiced oral health promotion activities when working with mental health consumers. When asked about barriers to promoting oral health, 'lack of consumer interest' was the most prevalent issue. CRSWs who had oral health training were over three-times (OR 3.5, 95% CI 1.25-9.83, p = 0.017) more likely to provide oral health support. Results showed the provision of oral health support was most strongly associated with self-rated knowledge and confidence (OR 4.089, 95% CI 1.629-10.263, p = 0.003) and attitudes to oral health promotion (OR 3.906, 95% CI 1.77-8.65, p = 0.001). CONCLUSION The results of this study suggest that mental health support workers who have more positive attitudes to oral health promotion and who have higher self-rated oral health knowledge and confidence are more likely to provide oral health support in their professional role. Training for community mental health professionals is essential to build confidence and skills to promote oral health for mental health consumers.
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Affiliation(s)
- Roisin McGrath
- The Melbourne Dental School, The University of Melbourne, Melbourne, VIC, 3053, Australia.
| | - Rodrigo Marino
- The Melbourne Dental School, The University of Melbourne, Melbourne, VIC, 3053, Australia
| | - Julie Satur
- The Melbourne Dental School, The University of Melbourne, Melbourne, VIC, 3053, Australia
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RESULTS OF RESEARCH THE MINERAL CONTENS OF THE BLOOD AND THE ORAL FLUID IN PREGNANT WOMEN SUFFERING FROM PERIODONTITIS AND IRON DEFICIENCY. WORLD OF MEDICINE AND BIOLOGY 2021. [DOI: 10.26724/2079-8334-2021-2-76-178-182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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10
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Parents' perceptions and related factors of the oral health status of Brazilian children enrolled in public preschools. Eur Arch Paediatr Dent 2020; 22:553-559. [PMID: 32897533 DOI: 10.1007/s40368-020-00563-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE This study aimed to evaluate parents' perceptions of the oral health status of children enrolled in public preschools and associated factors. METHODS This was a cross-sectional study with data collected via self-administered questionnaire. A total of 474 questionnaires were distributed in public preschools in the city of Canoas, Rio Grande do Sul, the southernmost state of Brazil. Poisson regression models were used in the multivariate analysis (p < 0.05). RESULTS The study included 171 (36%) valid questionnaires. The prevalence of parents who perceived the oral health status of their children as negative was 29.8% (n = 51). Mother being unemployed (vs employed) increased by 16% the likelihood of parents perceiving the oral health status of their children as negative (prevalence ratio [PR] 1.16; 95% confidence interval [CI] 1.02-1.31. Parents having (vs having not) observed difficulties in the child's ability to eat increased by 27% the likelihood of perceiving the child's oral health status as negative (PR 1.27; 95% CI 1.08-1.48), while child's tooth brushing 1-2 (vs 3 or more) times a day and family income up to 2 (vs 3 or more) minimum wages increased it by 14% (PR 1.14; 95% CI 1.03-1.27 for both). Current or past use (vs no use) of pacifiers increased by 12% the likelihood of parents' negative perceptions (PR 1.12; 95% CI 1.00-1.25). CONCLUSION We can conclude that unemployed mothers, low-income families, parents having observed child's feeding difficulties, child's tooth brushing 1-2 times a day, and current or past use of pacifiers contributed significantly to parents' negative perception of the child's oral health status. These factors are essential for the planning, implementation, monitoring, and evaluation of actions aimed at controlling the oral health of children enrolled in public preschools.
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Barriers and Predictors Associated With Accessing Oral Healthcare Among Patients With Cardiovascular Disease in Australia. J Cardiovasc Nurs 2020; 34:208-214. [PMID: 30589656 DOI: 10.1097/jcn.0000000000000559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Periodontal disease is associated with cardiovascular disease, and patients should be aware of this risk and seek dental care. OBJECTIVE In this study, the authors sought to identify the barriers and predictors for seeking oral healthcare among patients with cardiovascular disease. METHODS With the use of a cross-sectional descriptive study design, 307 patients with cardiovascular disease attending cardiac rehabilitation/outpatient cardiac clinics were surveyed between 2016 and 2017 in Sydney, Australia. Survey items included the prevalence of accessing dental services and a new "barriers to seeking frequent dental care" scale. RESULTS Most respondents (81%) reported at least 1 oral health problem, yet only 10% received any oral health information and more than half (58%) saw a dentist in the preceding 12 months. The barriers to seeking frequent dental care scale was internally consistent (Cronbach's α = 0.82) with 2 subscales, identified as personal-related and system-related barriers to accessing oral healthcare. Respondents were more likely to have seen a dentist in the previous 12 months if they received oral health information (adjusted odds ratio [AOR], 5.08; 95% confidence interval [CI], 1.62-15.93), had private health insurance (AOR, 3.33; 95% CI, 1.91-5.83), reported low barriers (AOR, 2.68; 95% CI, 1.61-4.47), or were born overseas (AOR, 2.13; 95% CI, 1.25-3.63). CONCLUSIONS The accessibility and affordability of dental care, as well as lack of oral health awareness, are key barriers and predictors for patients with cardiovascular disease accessing dental care. Greater emphasis on oral health is needed in the cardiac setting, along with appropriate dental referral pathways.
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Harnagea H, Couturier Y, Lamothe L, Emami E. [Integrating oral health care services into primary care in Quebec]. SANTE PUBLIQUE 2020; 31:809-816. [PMID: 32550663 DOI: 10.3917/spub.196.0809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Although integrated care is drawing considerable attention from health care policy makers, little is known about integration of oral health care services into primary care in Quebec. Therefore, the objective of this study was to compile information and compare the aspects of primary oral health care in two public health care organizations. METHOD An environmental scan was carried out in one rural and one urban primary health care organizations in Quebec. Data were collected from organizations' websites, operational documents, observational notes on facility visits, primary care meeting minutes, online pages of professional orders and face to face interviews (N = 74) and focus groups (N = 5), between November 2016 and October 2018. Thematic and Prior's documentation analyses were used to analyse the data. RESULTS Three themes were identified: normative aspects of integrated care delivery, integration trajectories, and integration initiatives. In both organizations, the integration of oral health into primary care rooted in public health sectors and dental teams were the key players. While urban center showed informal linkages between dental and non-dental primary care providers, the rural organization succeeded in coordination processes, even though these were also informal. CONCLUSION The majority of primary oral health care services are delivered in the public health sectors and the sustainability of integration initiatives in other primary health care sectors remains to be demonstrated. A better management of resources, as well as partnerships between public health care organizations and universities, could contribute to this integration.
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Abstract
PurposeIntegrating preventive oral care into prenatal care is suggested as a strategy for reducing the burden of oral diseases among pregnant women and their offspring. This scoping review sought to synthesize available information and identify knowledge gaps on integrating oral health into prenatal care.Design/methodology/approachThe scoping review was conducted based on the Joanna Briggs Institute scoping review framework using the following databases: CINAHL, Cochrane Database of Systematic Reviews, Medline, ProQuest Dissertation and theses Global, Psychinfo and Web of Science®. No search limits were used. Content analysis of the included articles was performed to identify conceptual frameworks, types of integration used, study designs, study objectives and outcomes.FindingsOverall, 2,861 references were obtained from the databases search; and based on the inclusion and exclusion criteria 35 references were included in the final analysis. Of these 35 references, one document presented a conceptual model, six documents reviewed guidelines for integrating oral health in prenatal care, two were policy documents aimed at interprofessional collaboration for oral health during pregnancy, eight documents described programs focused on providing oral care during pregnancy, five of the references were literature reviews and the remaining 13 evaluated the impact of integration. Linkages between healthcare professionals were the most common type of integration used.Research limitations/implicationsDespite advances in understanding integrated care concepts for healthcare delivery, there is little evidence available on the impact of the various types of, and strategies for, integrating oral health into prenatal care. Future research to bridge the identified gaps is recommended.Originality/valueThe originality of this study is to provide evidence on integrated oral healthcare during pregnancy.
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Riggs E, Kilpatrick N, Slack‐Smith L, Chadwick B, Yelland J, Muthu MS, Gomersall JC. Interventions with pregnant women, new mothers and other primary caregivers for preventing early childhood caries. Cochrane Database Syst Rev 2019; 2019:CD012155. [PMID: 31745970 PMCID: PMC6864402 DOI: 10.1002/14651858.cd012155.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Dental caries is one of the most common chronic diseases of childhood and is associated with adverse health and economic consequences for infants and their families. Socioeconomically disadvantaged children have a higher risk of early childhood caries (ECC). OBJECTIVES To assess the effects of interventions with pregnant women, new mothers or other primary caregivers of infants in the first year of life, for preventing ECC (from birth to six years of age). SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 14 January 2019), Cochrane Pregnancy and Childbirth Group's Trials Register (to 22 January 2019), Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Register of Studies, to 14 January 2019), MEDLINE Ovid (1946 to 14 January 2019), Embase Ovid (1980 to 14 January 2019) and CINAHL EBSCO (1937 to 14 January 2019). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on language or publication status. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing one or more interventions with pregnant women, mothers, or other caregivers of infants in the first year of life (intervention types included clinical, oral health education/promotion such as hygiene education, breastfeeding and other dietary advice, and policy or health service), versus standard care or placebo or another intervention. For inclusion, trials had to report at least one caries outcome. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial eligibility, extracted data, assessed risk of bias, and assessed certainty of evidence using the GRADE approach. MAIN RESULTS We included 17 RCTs (4 cluster-randomised), involving 23,732 caregivers (mainly mothers) and their children. Eleven RCTs assessed four oral health education/promotion interventions against standard care: child diet advice, child diet and feeding practice advice, breastfeeding promotion and support, and oral hygiene with child diet and feeding practice advice. Six trials assessed clinical interventions in mother's dentition, four trials chlorhexidine (CHX, a commonly prescribed antiseptic agent) or iodine-NaF application and prophylaxis versus placebo, and two trials xylitol against CHX or CHX + xylitol. At most, three trials (maximum of 1148 children and 130 mothers) contributed data to any comparison. For many trials, risk of bias was judged unclear due to lack of methodological details reported, and there was high risk of attrition bias in some trials. None of the included trials indicated receiving funding that is likely to have influenced their results. The trials were performed in high-, middle- and low-income countries. In nine trials, participants were socioeconomically disadvantaged. For child diet and feeding practice advice versus standard care, we observed a probable 15 per cent reduced risk of caries presence in primary teeth with the intervention (RR 0.85, 95% CI 0.75 to 0.97; 3 trials; 782 participants; moderate-certainty evidence), and there may be a lower mean dmfs (decayed, missing, filled primary surfaces) score (MD -0.29, 95% CI -0.58 to 0; 2 trials; 757 participants; low-certainty evidence); however, we are uncertain regarding the difference between the groups in mean dmft (decayed, missing, filled teeth) score (MD -0.90, 95% CI -1.85 to 0.05; 1 trial; 340 participants; very low-certainty evidence). For breastfeeding promotion and support versus standard care, we observed that there may be little or no a difference between groups in the risk of caries presence in primary teeth (RR 0.96, 95% CI 0.89 to 1.03; 2 trials; 1148 participants; low-certainty evidence), or mean dmft score (MD -0.12, 95% CI -0.59 to 0.36; 2 trials; 652 participants; low-certainty evidence). Dmfs was not reported for this comparison. We are uncertain whether child diet advice only compared with standard care reduces risk of caries presence in primary teeth (RR 1.08, 95% CI 0.34 to 3.37; 1 trial; 148 participants; very low-certainty evidence). Dmfs and dmft were not reported for this comparison. For oral hygiene, child diet and feeding practice advice versus standard care, we observed little or no reduced risk of caries presence in primary teeth (RR 0.91, 95% CI 0.75 to 1.10; 2 trials; 365 participants; low-certainty evidence), and are uncertain regarding difference between the groups in mean dmfs score (MD -0.99, 95% CI -2.45 to 0.47; 1 trial; 187 participants; very low-certainty evidence) and dmft score (MD -0.30, 95% CI -0.96 to 0.36; 1 trial; 187 participants; very low-certainty evidence). We observed there may be little or no difference in risk of caries presence in primary teeth between antimicrobial and placebo treatment in mother's dentition (RR 0.97, 95% CI 0.80 to 1.19; 3 trials; 479 participants; very low-certainty evidence). No trials assessing this comparison reported dmfs or dmft. For xylitol compared with CHX antimicrobial treatment, we observed there may be a lower mean dmft score with xylitol (MD -2.39; 95% CI -4.10 to -0.68; 1 trial, 113 participants; low-certainty evidence); however, we are uncertain regarding the difference between groups in caries presence in primary teeth (RR 0.62, 95% CI 0.27 to 1.39; 1 trial, 96 participants; very low-certainty evidence). Neither trial evaluating this comparison reported dmfs. No trials assessed a health policy or service intervention. AUTHORS' CONCLUSIONS Moderate-certainty evidence suggests that providing advice on diet and feeding to pregnant women, mothers or other caregivers with children up to the age of one year probably leads to a slightly reduced risk of early childhood caries (ECC). The remaining evidence is low to very low certainty and is insufficient for determining which, if any, other interventions types and features may be effective for preventing ECC. Large, high-quality RCTs of oral health education/promotion, clinical, and policy and service access interventions, are warranted to determine effects and relative effects of different interventions and inform practice. We have identified 12 studies currently in progress. Those designing future studies should describe the intervention components, setting and participants, consider if and how effects are modified by intervention features and participant characteristics, and adopt a consistent approach to measuring and reporting ECC.
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Affiliation(s)
- Elisha Riggs
- Murdoch Children's Research InstituteIntergenerational HealthFlemington RoadParkvilleVictoriaAustralia3052
- The University of MelbourneDepartment of General PracticeBerkeley StreetMelbourneVictoriaAustralia3000
| | - Nicky Kilpatrick
- Murdoch Children's Research InstituteVascular BiologyFlemington RoadParkvilleMelbourneVictoriaAustralia3052
- Royal Children's HospitalPlastic and Maxillofacial Surgery50 Flemington RoadParkvilleVictoriaAustralia3052
- The University of MelbourneDepartment of PaediatricsBerkeley StreetCarltonVictoriaAustralia3010
| | - Linda Slack‐Smith
- The University of Western AustraliaSchool of Population and Global Health35 Sterling Highway, CrawleyPerthWestern AustraliaAustralia6009
| | - Barbara Chadwick
- Cardiff UniversitySchool of DentistryHeath ParkCardiffUKCF14 4XY
| | - Jane Yelland
- Murdoch Children's Research InstituteIntergenerational HealthFlemington RoadParkvilleVictoriaAustralia3052
- The University of MelbourneDepartment of General PracticeBerkeley StreetMelbourneVictoriaAustralia3000
| | - M S Muthu
- Pedo Planet ‐ Children Dental CentersPediatric Dentistry161/62 A Mount Poonamallee RoadPorurChennaiIndia600116
- Sri Ramachandra Institute of Higher Education and ResearchCentre for Early Childhood Caries Research, Department of Pediatric and Preventive DentistryChennaiIndia
| | - Judith C Gomersall
- Women and Kids, South Australian Health and Medical Research InstituteWomen’s and Children’s Hospital7th Floor, 72 King William RoadAdelaideSouth AustraliaAustralia5006
- School of Public Health, University of AdelaideAdelaideAustralia
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15
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Bandeira MVR, Belarmino ADC, Anjos SDJSBD, Silva MRFD, Ferreira Junior AR. [Interprofessional collaboration for prenatal dental follow up in primary health care]. Salud Colect 2019; 15:e2224. [PMID: 32022130 DOI: 10.18294/sc.2019.2224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/24/2019] [Accepted: 08/27/2019] [Indexed: 11/24/2022] Open
Abstract
The aim of this study is to understand interprofessional teams' collaborative practices for prenatal dental follow-up in primary health care. An exploratory, qualitative and descriptive study was carried out, in which workers directly involved in prenatal care in the city of Fortaleza, Brazil were included. A total of 24 individual semi structured in depth interviews were conducted between June and August of 2018. The information was organized based on a thematic analysis, and the hermeneutic dialectic method was used for the theoretical foundation and interpretation. Three discursive categories were identified: professional perceptions about collaborative practice, challenges in interprofessional collaboration, and collaboration practices within the team. The professionals' perception about interprofessional collaboration in maternal and child care was favorable, although in some cases the interdisciplinary work practice was not effective due to the existence of barriers that hindered its fulfillment.
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Affiliation(s)
| | - Adriano da Costa Belarmino
- Enfermero. Especialista en Enfermería Obstétrica y Neonatal. Universidade Estadual do Ceará, Fortaleza, Ceará, Brasil.
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George A, Sousa MS, Kong AC, Blinkhorn A, Patterson Norrie T, Foster J, Dahlen HG, Ajwani S, Johnson M. Effectiveness of preventive dental programs offered to mothers by non-dental professionals to control early childhood dental caries: a review. BMC Oral Health 2019; 19:172. [PMID: 31375106 PMCID: PMC6679429 DOI: 10.1186/s12903-019-0862-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/24/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Early childhood caries is a common chronic childhood disease and maternal oral health is a risk factor. Improving the oral health behaviours of pregnant women/young mothers can positively influence the oral health of children and reduce their caries risk. Such preventative strategies have been undertaken by non-dental professionals producing mixed results encompassing various interventions across the perinatal period. However, no comprehensive review of these studies has been undertaken. The aim of this review was to assess the effectiveness of maternal oral health programs undertaken during the antenatal and/or postnatal period by non-dental health professionals to reduce early childhood caries. METHODS A systematic search of five databases was undertaken using key search terms. Studies were included if they (a) involved quantitative study designs with a control; (b) were published in English; (c) reported on interventions delivered by non-dental professionals (d) delivered the intervention to expectant mothers or mothers with young infants up to 24 months; (e) measured outcomes when the child was under 5 years; (f) measured changes in oral health outcomes of children clinically and oral health behaviours of mothers or children. No restrictions were placed on the study quality and setting. RESULTS Nine studies met the inclusion criteria and involved interventions delivered by diverse non-dental professionals across the antenatal (n = 1), postnatal (n = 6) and perinatal period (n = 2). Most studies were of low methodological quality (n = 6). The interventions focussed on oral health education (n = 8), dental referrals (n = 3) and oral health assessments (n = 1). Interventions conducted in either the postnatal or antenatal periods showed meaningful improvements in children's clinical and mother's behavioural oral health outcomes. The outcomes appear to be sustained when a suite of interventions were used along with referral reminders. There were mixed results from interventions across the perinatal period. CONCLUSIONS Non-dental professionals can promote maternal oral health by providing oral health education, risk assessment and referrals. Combining these interventions could provide a sustained improvement in oral health outcomes for children although current evidence is weak. More high-quality studies are needed to confirm these findings and determine whether the antenatal and/or postnatal period is best suited to deliver these interventions.
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Affiliation(s)
- Ajesh George
- Centre for Oral Health Outcomes and Research Translation (COHORT), School of Nursing and Midwifery, Western Sydney University/South Western Sydney Local Health District, Liverpool, NSW 2170 Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170 Australia
- Translational Health Research Institute, Campbelltown, NSW 2560 Australia
- School of Dentistry, Faculty of Medicine and Health, University of Sydney, Camperdown, 2050 Australia
| | - Mariana S. Sousa
- Centre for Oral Health Outcomes and Research Translation (COHORT), School of Nursing and Midwifery, Western Sydney University/South Western Sydney Local Health District, Liverpool, NSW 2170 Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170 Australia
| | - Ariana C. Kong
- Centre for Oral Health Outcomes and Research Translation (COHORT), School of Nursing and Midwifery, Western Sydney University/South Western Sydney Local Health District, Liverpool, NSW 2170 Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170 Australia
| | - Anthony Blinkhorn
- School of Dentistry, Faculty of Medicine and Health, University of Sydney, Camperdown, 2050 Australia
| | - Tiffany Patterson Norrie
- Centre for Oral Health Outcomes and Research Translation (COHORT), School of Nursing and Midwifery, Western Sydney University/South Western Sydney Local Health District, Liverpool, NSW 2170 Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170 Australia
| | - Jann Foster
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170 Australia
- School of Nursing & Midwifery, Western Sydney University, Penrith, NSW 2560 Australia
| | - Hannah G. Dahlen
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170 Australia
- School of Nursing & Midwifery, Western Sydney University, Penrith, NSW 2560 Australia
| | - Shilpi Ajwani
- School of Dentistry, Faculty of Medicine and Health, University of Sydney, Camperdown, 2050 Australia
- Sydney Local Health District Oral Health Services, Sydney Dental Hospital/University of Sydney, Sydney, 2010 Australia
| | - Maree Johnson
- Faculty of Health Sciences, Australian Catholic University, North Sydney, NSW 2060 Australia
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Marchi KS, Rinki C, Shah M, Dove M, Terpak C, Curtis MP, Braveman P. Medical Provider Promotion of Oral Health and Women’s Receipt of Dental Care During Pregnancy. Matern Child Health J 2019; 23:890-902. [DOI: 10.1007/s10995-018-02714-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Xiao J, Alkhers N, Kopycka-Kedzierawski DT, Billings RJ, Wu TT, Castillo DA, Rasubala L, Malmstrom H, Ren Y, Eliav E. Prenatal Oral Health Care and Early Childhood Caries Prevention: A Systematic Review and Meta-Analysis. Caries Res 2019; 53:411-421. [PMID: 30630167 PMCID: PMC6554051 DOI: 10.1159/000495187] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/31/2018] [Indexed: 11/19/2022] Open
Abstract
Despite the advancement of early childhood caries (ECC) prediction and treatment, ECC remains a significant public health burden in need of more effective preventive strategies. Pregnancy is an ideal period to promote ECC prevention given the profound influence of maternal oral health and behaviors on children's oral health. However, studies have shown debatable results with respect to the effectiveness of ECC prevention by means of prenatal intervention. Therefore, this study systematically reviewed the scientific evidence relating to the association between prenatal oral health care, ECC incidence, and Streptococcus mutans carriage in children. Five studies (3 randomized control trials, 1 prospective cohort study, and 1 nested case-control study) were included for qualitative assessment. Tested prenatal oral health care included providing fluoride supplements, oral examinations/cleanings, oral health education, dental treatment referrals, and xylitol gum chewing. Four studies that assessed ECC incidence reduction were included in meta-analysis using an unconditional generalized linear mixed effects model with random study effects and age as a covariate. The estimated odds ratio and 95% confidence intervals suggested a protective effect of prenatal oral health care against ECC onset before 4 years of age: 0.12 (0.02, 0.77) at 1 year of age, 0.18 (0.05, 0.63) at 2 years of age, 0.25 (0.09, 0.64) at 3 years of age, and 0.35 (0.12, 1.00) at 4 years of age. Children's S. mutans carriage was also significantly reduced in the intervention group. Future studies should consider testing strategies that restore an expectant mother's oral health to a disease-free state during pregnancy.
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Affiliation(s)
- Jin Xiao
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA,
| | - Naemah Alkhers
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA
| | | | - Ronald J Billings
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA
| | - Tong Tong Wu
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, USA
| | - Daniel A Castillo
- Miner Library, University of Rochester Medical Center, Rochester, New York, USA
| | - Linda Rasubala
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA
| | - Hans Malmstrom
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA
| | - Yanfang Ren
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA
| | - Eli Eliav
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA
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Ajwani S, Sousa MS, Villarosa AC, Bhole S, Johnson M, Dahlen HG, Hoolsema J, Blinkhorn A, Srinivas R, Yaacoub A, Milat A, Skinner J, George A. Process evaluation of the midwifery initiated oral health-dental service program: Perceptions of dental professionals. Health Promot J Austr 2018; 30:333-343. [PMID: 30512207 DOI: 10.1002/hpja.224] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 11/30/2018] [Indexed: 01/31/2023] Open
Abstract
ISSUE ADDRESSED All pregnant women should have a comprehensive oral health evaluation. Unfortunately, many pregnant women seldom seek dental care and some dentists are hesitant to treat during pregnancy. To address these issues, the Midwifery Initiated Oral Health Dental Service (MIOH-DS) program was developed in Australia. The aim of this study was to undertake a process evaluation and explore the perceptions of dental professionals involved in the program to determine the acceptability, feasibility and effectiveness of the program if it were to be upscaled. METHODS A qualitative approach using content analysis was conducted on data from two focus groups involving 12 dental professionals. RESULTS All participants were supportive of the MIOH-DS program. They thought pregnant women were receptive to their care, and reported markedly improved oral health. The provision of free dental care and the involvement of midwives were cited as major factors that improved the uptake of the program. Some of the challenges encountered were the prevailing misconceptions about the safety of dental treatment and pregnancy-related impairments. CONCLUSIONS Dental professionals found the MIOH-DS to be acceptable, feasible and effective in improving oral health of pregnant women and their uptake of dental services. However, some challenges need to be addressed as the MIOH-DS program is upscaled into a cost-effective model. SO WHAT?: Dental professionals are important stakeholders in the MIOH-DS model. The process evaluation of the successful dental intervention is necessary to understand how and why such interventions work, and is an important step in scaling up to a population-wide intervention.
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Affiliation(s)
- Shilpi Ajwani
- Sydney Local Health District Oral Health Services/Sydney Dental Hospital/University of Sydney, Sydney Research, Sydney, NSW, Australia
| | - Mariana S Sousa
- Centre for Oral Health Outcomes & Research Translation (COHORT), Western Sydney University/South Western Sydney Local Health District/Ingham Institute Applied Medical Research/Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Ariana C Villarosa
- COHORT, Western Sydney University/South Western Sydney Local Health District/Ingham Institute Applied Medical Research, Liverpool, NSW, Australia
| | - Sameer Bhole
- Sydney Local Health District Oral Health Services/Sydney Dental Hospital/University of Sydney, Sydney Research, Sydney, NSW, Australia
| | - Maree Johnson
- Faculty of Health Sciences, Australian Catholic University/Ingham Institute Applied Medical Research, Sydney, NSW, Australia
| | - Hannah G Dahlen
- School of Nursing & Midwifery, Western Sydney University/Ingham Institute Applied Medical Research, Parramatta, NSW, Australia
| | - Julia Hoolsema
- COHORT, Western Sydney University/South Western Sydney Local Health District/Ingham Institute Applied Medical Research, Liverpool, NSW, Australia
| | | | - Ravi Srinivas
- COHORT, South Western Sydney Local Health District Oral Health Services, Western Sydney University/Ingham Institute Applied Medical Research/University of Sydney, Liverpool, NSW, Australia
| | - Albert Yaacoub
- Nepean Blue Mountains Local Health District Oral Health Services, Penrith, NSW, Australia
| | - Andrew Milat
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - John Skinner
- Faculty of Dentistry, University of Sydney, Sydney, NSW, Australia
| | - Ajesh George
- COHORT, Western Sydney University/South Western Sydney Local Health District/University of Sydney/Ingham Institute Applied Medical Research, Translational Health Research Institute, Liverpool, NSW, Australia
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George A, Villarosa AR, Patterson Norrie T, Hoolsema J, Dahlen HG, Ajwani S, Bhole S, Blinkhorn A, Srinivas R, Yaacoub A, Milat A, Skinner J, Johnson M. Process evaluation of the midwifery initiated oral health-dental service program: perceptions of pregnant women. Aust Dent J 2018; 64:55-65. [PMID: 30375645 DOI: 10.1111/adj.12660] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pregnant women in Australia seldom seek dental care and are unaware of its importance. To address these gaps the midwifery-initiated oral health dental service (MIOH-DS) program was comprehensive trialled and found effective. The aim of this study was to undertake a process evaluation of the MIOH-DS using the perspectives of pregnant women who participated in the trial. METHODS A qualitative research design was utilized, whereby content analysis was undertaken on data from 11 semi-structured interviews with women who participated in the program. RESULTS All participants were receptive of the MIOH-DS intervention, and found it to be an acceptable intervention that met their needs, and encouraged future positive oral health practices and health-seeking behaviours. They expressed that midwives were an appropriate professional to conduct oral health assessments, education and referrals to affordable dental services. Although some participants were initially apprehensive towards receiving treatment during pregnancy, dental staff members were able to appropriately educate and reassure them during treatment. CONCLUSIONS The MIOH-DS represents a promising and acceptable intervention strategy for pregnant women to promote their oral health. Findings merit further investigation on whether positive outcomes achieved can be sustained when implemented in other national or international settings similar to the study setting.
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Affiliation(s)
- A George
- Centre for Oral Health Outcomes & Research Translation (COHORT), Western Sydney University, South Western Sydney Local Health District, University of Sydney, Liverpool, New South Wales, Australia.,Ingham Institute Applied Medical Research, Translational Health Research Institute, Liverpool, New South Wales, Australia
| | - A R Villarosa
- COHORT, Western Sydney University, South Western Sydney Local Health District, Liverpool, New South Wales, Australia.,Ingham Institute Applied Medical Research, Liverpool, New South Wales, Australia
| | - T Patterson Norrie
- COHORT, Western Sydney University, South Western Sydney Local Health District, Liverpool, New South Wales, Australia.,Ingham Institute Applied Medical Research, Liverpool, New South Wales, Australia
| | - J Hoolsema
- COHORT, Western Sydney University, South Western Sydney Local Health District, Liverpool, New South Wales, Australia.,Ingham Institute Applied Medical Research, Liverpool, New South Wales, Australia
| | - H G Dahlen
- School of Nursing & Midwifery, Ingham Institute Applied Medical Research, Western Sydney University, Parramatta, New South Wales, Australia
| | - S Ajwani
- Sydney Local Health District Oral Health Services, Sydney Dental Hospital, Sydney Research, University of Sydney, Sydney, New South Wales, Australia
| | - S Bhole
- Sydney Local Health District Oral Health Services, Sydney Dental Hospital, Sydney Research, University of Sydney, Sydney, New South Wales, Australia
| | - A Blinkhorn
- Faculty of Dentistry, University of Sydney, Sydney, New South Wales, Australia
| | - R Srinivas
- Centre for Oral Health Outcomes & Research Translation (COHORT), Western Sydney University, South Western Sydney Local Health District, University of Sydney, Liverpool, New South Wales, Australia.,Ingham Institute Applied Medical Research, Translational Health Research Institute, Liverpool, New South Wales, Australia
| | - A Yaacoub
- Nepean Blue Mountains Local Health District Oral Health Services, Penrith, New South Wales, Australia
| | - A Milat
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - J Skinner
- Faculty of Dentistry, University of Sydney, Sydney, New South Wales, Australia
| | - M Johnson
- Ingham Institute Applied Medical Research, Liverpool, New South Wales, Australia.,Faculty of Health Sciences, Australian Catholic University, Sydney, New South Wales, Australia
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George A, Dahlen HG, Blinkhorn A, Ajwani S, Bhole S, Ellis S, Yeo A, Elcombe E, Johnson M. Evaluation of a midwifery initiated oral health-dental service program to improve oral health and birth outcomes for pregnant women: A multi-centre randomised controlled trial. Int J Nurs Stud 2018; 82:49-57. [PMID: 29605753 DOI: 10.1016/j.ijnurstu.2018.03.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 01/19/2018] [Accepted: 03/05/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Oral health care during pregnancy is important for the health of the mother and child. However, pregnant women have limited knowledge about maternal oral health and seldom seek dental care. Further, due to limited training antenatal care providers like midwives rarely discuss oral health with pregnant women. The Midwifery-Initiated Oral Health Dental Service program was developed to address current gaps in oral promotional interventions during pregnancy. OBJECTIVES To assess the effectiveness of a Midwifery-Initiated Oral Health Dental Service program in improving uptake of dental services, oral health knowledge, quality of oral health, oral health status and birth outcomes of pregnant women. DESIGN Multi-centre randomised controlled trial. SETTING Three large metropolitan public hospitals in Sydney, Australia. PARTICIPANTS Pregnant women attending their first antenatal appointment who were at least 18 years old and had a single low risk pregnancy between 12 and 20 weeks gestation. METHODS 638 pregnant women were allocated to three groups using block randomisation (n = 211) control group, intervention group 1 (n = 215), intervention group 2 (n = 212) and followed up till birth. Study investigators and data collectors were blinded to group allocation. Intervention group 1 received a midwifery intervention from trained midwives involving oral health education, screening and referrals to existing dental pathways. Intervention group 2 received the midwifery intervention and a dental intervention involving assessment/treatment from cost free local dental services. The control group received oral health information at recruitment. Primary outcome was uptake of dental services. Secondary outcomes included oral health knowledge, quality of oral health, oral health status and birth outcomes. RESULTS Substantial improvements in the use of dental services (20.2% Control Group; 28.3% Intervention group 1; 87.2% Intervention group 2; Odds Ratio Intervention group 2 vs Control Group = 29.72, 95% CI 15.02-58.53, p < 0.001), women's oral health knowledge (p = 0.03); quality of oral health (p < 0.001) and oral health outcomes (sulcus bleeding, dental plaque, clinical attachment loss, decayed/filled teeth- p < 0.001) were found in Intervention group 2. No difference in the rate of preterm or low-birth weight was found. CONCLUSIONS The Midwifery-Initiated Oral Health Dental Service program (Intervention group 2) improved the uptake of dental services and oral health of pregnant women and is recommended during antenatal care. A cause and effect relationship between this intervention and improved birth outcomes was not supported.
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Affiliation(s)
- Ajesh George
- Centre for Oral Health Outcomes, Research Translation and Evaluation (COHORTE), Western Sydney University, South Western Sydney Local Health District Oral Health Services, University of Sydney, Ingham Institute Applied Medical Research, Liverpool 1871, Australia.
| | - Hannah G Dahlen
- School of Nursing & Midwifery, Western Sydney University, Ingham Institute Applied Medical Research, Parramatta 2150, Australia
| | | | - Shilpi Ajwani
- Sydney Local Health District Oral Health Services, Sydney Dental Hospital, University of Sydney, Sydney 2010, Australia; Sydney Research, Sydney 2010, Australia
| | - Sameer Bhole
- Sydney Local Health District Oral Health Services, Sydney Dental Hospital, University of Sydney, Sydney 2010, Australia; Sydney Research, Sydney 2010, Australia
| | - Sharon Ellis
- Camden and Campbelltown Hospitals, South Western Sydney Local Health District, Campbelltown 2170, Australia
| | - Anthony Yeo
- School of Nursing & Midwifery, University of Western Sydney, Liverpool, 1871, Australia
| | - Emma Elcombe
- Western Sydney University, University of New South Wales, Ingham Institute Applied Medical Research, Liverpool 1871, Australia
| | - Maree Johnson
- Faculty of Health Sciences, Australian Catholic University, Sydney 2060, Australia; Ingham Institute Applied Medical Research, Liverpool 1871, Australia
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Arora A, Manohar N, Bedros D, Hua APD, You SYH, Blight V, Ajwani S, Eastwood J, Bhole S. Lessons learnt in recruiting disadvantaged families to a birth cohort study. BMC Nurs 2018; 17:7. [PMID: 29491745 PMCID: PMC5828325 DOI: 10.1186/s12912-018-0276-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 02/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dental decay in early childhood can be prevented by a model based on shared care utilising members of primary care team such as Child and Family Health Nurses (CFHNs) in health promotion and early intervention. The aims of this study were to identify the facilitators and barriers faced by CFHNs in recruiting research participants from disadvantaged backgrounds to a birth cohort study in South Western Sydney, Australia. METHODS Child and Family Health Nurses recruited mothers-infants dyads (n = 1036) at the first post-natal home visit as part of Healthy Smiles Healthy Kids Study, an ongoing birth cohort study in South Western Sydney. The nurses (n = 19) were purposively selected and approached for a phone based in-depth semi-structured interview to identify the challenges faced by them during the recruitment process. Interviews were audio-recorded, subsequently transcribed verbatim and analysed by thematic analysis. RESULTS The nurses found the early phase of parenting was an overwhelming stage for parents as they are pre-occupied with more immediate issues such as settling and feeding a newborn. They highlighted some key time-points such as during pregnancy and/or around the time of infant teething may be more appropriate for recruiting families to dental research projects. However, they found it easier to secure the family's attention by offering incentives, gifts and invitations for free oral health services. The use of web-based approaches and maintaining regular contact with the participants was deemed crucial for long-term research. Cultural and linguistic barriers were seen as an obstacle in recruiting ethnic minority populations and the need for cultural insiders in the research team was deemed important to resolve the challenges associated with conducting research with diverse cultures. Finally, nurses identified the importance of inter-professional collaboration to provide easier access to recruiting research participants. CONCLUSIONS This study highlighted the need for multiple time-points and incentives to facilitate recruitment and retention of disadvantaged communities in longitudinal research. The need for cultural insiders and inter-professional collaboration in research team are important to improve research participation.
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Affiliation(s)
- Amit Arora
- School of Science and Health, Western Sydney University, 24.2.97 Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2751 Australia
- Sydney Dental Hospital and Oral Health Services, Sydney Local Health District, Surry Hills, NSW Australia
- Discipline of Paediatrics and Child Health, Sydney Medical School, Westmead, NSW Australia
- Collaboration for Oral Health Outcomes Research, Translation, and Evaluation (COHORTE) Research Group, Ingham Institute for Applied Medical Research, Liverpool, NSW Australia
| | - Narendar Manohar
- School of Science and Health, Western Sydney University, 24.2.97 Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Dina Bedros
- Faculty of Dentistry, The University of Sydney, Surry Hills, NSW Australia
| | | | | | - Victoria Blight
- Child and Family Health Nursing, Primary & Community Health, South Western Sydney Local Health District, Narellan, NSW Australia
| | - Shilpi Ajwani
- Sydney Dental Hospital and Oral Health Services, Sydney Local Health District, Surry Hills, NSW Australia
- Faculty of Dentistry, The University of Sydney, Surry Hills, NSW Australia
| | - John Eastwood
- Department of Community Paediatrics, Sydney Local Health District, Croydon Community Health Centre, Croydon, NSW Australia
- Sydney Medical School, The University of Sydney, Sydney, NSW Australia
- School of Women’s and Children’s Health, UNSW Australia, Kensington, NSW Australia
- School of Medicine, Griffith University, Gold Coast, QLD Australia
| | - Sameer Bhole
- Sydney Dental Hospital and Oral Health Services, Sydney Local Health District, Surry Hills, NSW Australia
- Faculty of Dentistry, The University of Sydney, Surry Hills, NSW Australia
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An Umbrella Review Exploring the Effect of Periodontal Treatment in Pregnant Women on the Frequency of Adverse Obstetric Outcomes. J Evid Based Dent Pract 2017; 18:218-239. [PMID: 30077375 DOI: 10.1016/j.jebdp.2017.10.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 10/27/2017] [Accepted: 10/27/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE In the recent years, efforts have been made to reduce epidemiologic indicators of periodontal disease in pregnant women. This umbrella review aims to analyze the systematic reviews/meta-analyses investigating the effect of periodontal therapy in pregnant women on the frequency of obstetric complications (low birth weight, preterm delivery, and preeclampsia) and to identify the gaps in the scientific literature. METHODS A systematic review of systematic reviews with and without meta-analysis of intervention studies was conducted. Quality evaluation and qualitative analysis of the reviews were performed. RESULTS A total of 223 articles were obtained, and 18 of them were included in the analysis, 13 articles included meta-analysis, where 11 were of high quality and 7 of medium quality according to the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) guide. These systematic reviews/meta-analyses included a total of 19 studies (17 randomized clinical trials). Descriptive systematic reviews showed that periodontal therapy has positive effects on reducing the frequency of adverse pregnancy outcomes. In systematic reviews with meta-analysis, overall effect estimators were not significant, although a reduction in the incidence of obstetric complications was observed. Subgroup analysis resulted in significant effects, depending on sociodemographic conditions. CONCLUSIONS Differential findings are not enough to demonstrate that there is a significant reduction in the frequency of adverse pregnancy outcomes in pregnant women receiving periodontal therapy. Possible explanations are related to factors such as the type of studies analyzed, indicator of obstetric complication considered, and specific variables included in the analysis. Many systematic reviews did not address publication bias and did identify gaps in knowledge that require further clarification.
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Poudel P, Griffiths R, Wong VW, Arora A, George A. Knowledge and practices of diabetes care providers in oral health care and their potential role in oral health promotion: A scoping review. Diabetes Res Clin Pract 2017; 130:266-277. [PMID: 28662464 DOI: 10.1016/j.diabres.2017.06.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 04/21/2017] [Accepted: 06/06/2017] [Indexed: 12/17/2022]
Abstract
AIM Oral health complications are common in people with diabetes yet very little is reported about the oral health care provided in diabetes care setting. This study reviewed global evidence on the oral health care knowledge and practices of diabetes care providers and the role of non-dental health professionals in oral health promotion. METHODS A systematic search of five databases was undertaken with key search terms using a scoping review framework. Relevant studies published till October 2016 in the English language were included (n=30) and no restrictions were placed on the study design, quality or setting. RESULTS Most diabetes care providers are not addressing oral health care with the main barriers being time constraints and limited oral health knowledge. Diabetes educators (DEs) could engage in oral health promotion with few studies showing this model of care can translate into improved patient outcomes. However, no appropriate oral health training programs and assessment tools exist for DEs. With proper training, non-dental professionals like nurses have successfully incorporated oral healthcare in other settings. CONCLUSIONS DEs are well placed to promote oral health in diabetes care setting. Further research is needed to identify barriers and oral health resources to support DEs in this role.
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Affiliation(s)
- Prakash Poudel
- Collaboration for Oral Health Outcomes, Research Translation and Evaluation (COHORTE) Research Group, Western Sydney University, South Western Sydney Local Health District, Ingham Institute Applied Medical Research, Locked Bag 7103, Liverpool 1871, Australia.
| | - Rhonda Griffiths
- School of Nursing & Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 1797, Australia
| | - Vincent W Wong
- Diabetes and Endocrine Service, Liverpool Hospital, Liverpool Diabetes Collaborative Research Unit, Ingham Institute Applied Medical Research, South Western Clinical School, University of New South Wales, Locked Bag 7103, Liverpool BC, NSW 1871, Australia
| | - Amit Arora
- School of Science and Health, Western Sydney University, COHORTE Research Group, South Western Sydney Local Health District, Ingham Institute Applied Medical Research, Sydney Medical School, University of Sydney, Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, Building 24.2.97, Campbelltown Campus, WSU, NSW 2560, Australia
| | - Ajesh George
- COHORTE Research Group, Western Sydney University, South Western Sydney Local Health District, Ingham Institute Applied Medical Research, University of Sydney, Locked Bag 7103, Liverpool 1871, Australia
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George A, Ajwani S, Bhole S, Dahlen HG, Reath J, Korda A, Ng Chok H, Miranda C, Villarosa A, Johnson M. Knowledge, attitude and practises of dentists towards oral health care during pregnancy: A cross sectional survey in New South Wales, Australia. Aust Dent J 2017; 62:301-310. [DOI: 10.1111/adj.12505] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2017] [Indexed: 01/23/2023]
Affiliation(s)
- A George
- Collaboration for Oral Health Outcomes, Research Translation and Evaluation (COHORTE) Research Group; Western Sydney University, South Western Sydney Local Health District, Ingham Institute Applied Medical Research, University of Sydney; Liverpool New South Wales Australia
| | - S Ajwani
- Sydney Local Health District Oral Health Services, Sydney Dental Hospital, University of Sydney; Sydney New South Wales Australia
| | - S Bhole
- Sydney Local Health District Oral Health Services, Sydney Dental Hospital/University of Sydney; Sydney New South Wales Australia
| | - HG Dahlen
- School of Nursing and Midwifery; Western Sydney University/Ingham Institute Applied Medical Research; Parramatta New South Wales Australia
| | - J Reath
- Peter Brennan Chair of General Practice, School of Medicine, Western Sydney University; Campbelltown New South Wales Australia
| | - A Korda
- Obstetrics and Gynaecology, School of Medicine, Western Sydney University; Campbelltown New South Wales Australia
| | - H Ng Chok
- Centre for Nursing Research and Practice Development; Western Sydney University/Nepean Blue Mountains Local Health District; Penrith New South Wales Australia
| | - C Miranda
- College of Professional Psychology; Crows Nest New South Wales Australia
| | - A Villarosa
- COHORTE Research Group; Western Sydney University/South Western Sydney Local Health District/Ingham Institute Applied Medical Research; Liverpool New South Wales Australia
| | - M Johnson
- Faculty of Health Sciences; Australian Catholic University, Ingham Institute Applied Medical Research; Sydney New South Wales Australia
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George A, Dahlen HG, Reath J, Ajwani S, Bhole S, Korda A, Chok HN, Miranda C, Villarosa A, Johnson M. What do antenatal care providers understand and do about oral health care during pregnancy: a cross-sectional survey in New South Wales, Australia. BMC Pregnancy Childbirth 2016; 16:382. [PMID: 27903257 PMCID: PMC5131399 DOI: 10.1186/s12884-016-1163-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 11/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is mounting evidence to support the lack of awareness among pregnant women about health consequences and long term risks associated with poor oral hygiene during pregnancy. A recognised and important point of influence is their interaction with health professionals, particularly when receiving Antenatal Care. However, there is limited evidence about the perceptions of ANC providers in Australia toward the provision of perinatal oral healthcare. This study was undertaken to explore the knowledge, attitudes and practices of Antenatal Care (ANC) providers in New South Wales (NSW), Australia providing perinatal oral healthcare and to identify barriers to and predictors of their practices in this area. METHODS A cross sectional survey was undertaken of ANC providers (general practitioners, obstetricians/gynaecologists and midwives) practising in NSW, Australia. Participants were recruited through their professional organisations via email, postal mail, and networking at conferences. The survey addressed the domains of knowledge, attitude, barriers and practices towards oral healthcare, along with demographics. Data was entered into SPSS software and analysed using descriptive and inferential statistics. RESULTS A total of 393 surveys (17.6% response rate) were completed comprising 124 general practitioners, 74 obstetricians/gynaecologists and 195 midwives. The results showed limited knowledge among ANC providers regarding the impact of poor maternal oral health on pregnancy/infant outcomes. Most (99%) participants agreed that maternal oral health was important yet few were discussing the importance of oral health or advising women to visit a dentist (16.4-21.5%). Further, less than a third felt they had the skills to provide oral health advice during pregnancy. ANC providers who were more knowledgeable about maternal oral health, had training and information in this area and greater experience, were more likely to engage in practices addressing the oral health of pregnant women. CONCLUSION The findings suggest that ANC providers in NSW are not focussing on oral health with pregnant women. ANC providers seem willing to discuss oral health if they have appropriate education/training and information in this area. Further research at a national level is required to confirm whether these findings are similar in all Australian states.
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Affiliation(s)
- Ajesh George
- Collaboration for Oral Health Outcomes, Research Translation and Evaluation (COHORTE) Research Group, Western Sydney University, South Western Sydney Local Health District, Ingham Institute Applied Medical Research,University of Sydney, Locked Bag 7103, Liverpool, 1871, Australia.
| | - Hannah G Dahlen
- School of Nursing & Midwifery, Western Sydney University, Ingham Institute Applied Medical Research, Parramatta, 2150, Australia
| | - Jennifer Reath
- Peter Brennan Chair of General Practice, School of Medicine, Western Sydney University, Parramatta, 2150, Australia
| | - Shilpi Ajwani
- Sydney Local Health District Oral Health Services, Sydney Dental Hospital, University of Sydney, Sydney, 2010, Australia
| | - Sameer Bhole
- Sydney Local Health District Oral Health Services, Sydney Dental Hospital, University of Sydney, Sydney, 2010, Australia
| | - Andrew Korda
- Obstetrics and Gynaecology, School of Medicine, Western Sydney University, Parramatta, 2150, Australia
| | - Harrison Ng Chok
- Centre for Nursing Research and Practice Development, Western Sydney University, Nepean Blue Mountains Local Health District, Penrith, 2751, Australia
| | | | - Amy Villarosa
- COHORTE Research Group, Western Sydney University, South Western Sydney Local Health District, Ingham Institute Applied Medical Research, Liverpool, 1871, Australia
| | - Maree Johnson
- Faculty of Health Sciences, Australian Catholic University, Ingham Institute Applied Medical Research, Sydney, 2060, Australia
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George A, Dahlen HG, Blinkhorn A, Ajwani S, Bhole S, Ellis S, Yeo A, Elcombe E, Sadozai A, Johnson M. Measuring oral health during pregnancy: sensitivity and specificity of a maternal oral screening (MOS) tool. BMC Pregnancy Childbirth 2016; 16:347. [PMID: 27829388 PMCID: PMC5103484 DOI: 10.1186/s12884-016-1140-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 10/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Midwives can play a key role in promoting the oral health of pregnant women and assessing their oral health status. A maternal oral assessment tool (MOS) was developed and pilot tested by the study investigators to assist midwives in this role and the results were promising. The aim of this study was to undertake further sensitivity and specificity assessment of the MOS tool using two-comparison approaches- the longer oral health screening tool known as the Oral Health Impact Profile (OHIP-14) and an oral assessment by trained study dentists. METHODS Pregnant women were recruited for this study as part of a larger randomised controlled trial of a Midwifery Initiated Oral Health (MIOH) program. Pregnant women completed the MOS and OHIP-14 as part of their initial assessment undertaken by 38 trained and accredited midwives. A dental assessment was conducted for all women in the intervention group using three trained study dentists with high inter rater reliability. RESULTS Two hundred and eleven pregnant women participated in the validation of the MOS tool. Results from both approaches found the MOS tool to have high sensitivity, correctly identifying 88-94 % of women at risk of poor dental health, and low specificity (14-21 %). CONCLUSIONS This study has shown that the MOS tool can be successfully implemented by midwives during a woman's first antenatal visit and can identify up to 94 % of women at risk of poor oral health and needing a dental referral. The tool has the potential to be transferable to other antenatal care providers and could be incorporated into hospital obstetric database systems. TRIAL REGISTRATION NUMBER ACTRN12612001271897 , 6th Dec 2012, retrospectively registered.
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Affiliation(s)
- Ajesh George
- Collaboration for Oral Health Outcomes, Research Translation and Evaluation (COHORTE) Research Group, Western Sydney University, South Western Sydney Local Health District, Ingham Institute Applied Medical Research, University of Sydney, Liverpool BC, Locked Bag 7103, Liverpool, NSW 1871 Australia
| | - Hannah G. Dahlen
- School of Nursing & Midwifery, Western Sydney University, Ingham Institute Applied Medical Research, Parramatta, 2150 Australia
| | | | - Shilpi Ajwani
- Sydney Local Health District Oral Health Services, Sydney Dental Hospital, University of Sydney, Sydney, 2010 Australia
| | - Sameer Bhole
- Sydney Local Health District Oral Health Services, Sydney Dental Hospital, University of Sydney, Sydney, 2010 Australia
| | - Sharon Ellis
- Antenatal Services, Camden and Campbelltown Hospitals, South Western Sydney Local Health District, Campbelltown, 2560 Australia
| | - Anthony Yeo
- School of Nursing & Midwifery, Western Sydney University, Parramatta, 2150 Australia
| | - Emma Elcombe
- Western Sydney University, University of New South Wales, Ingham Institute Applied Medical Research, Liverpool, 2170 Australia
| | - Ayesha Sadozai
- Centre for Applied Nursing Research, Western Sydney University, South Western Sydney Local Health District, Ingham Institute Applied Medical Research, Liverpool, 1871 Australia
| | - Maree Johnson
- Faculty of Health Sciences, Australian Catholic University, Ingham Institute Applied Medical Research, Sydney, 2060 Australia
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Educational intervention to improve oral health beliefs and behaviors during pregnancy: a randomized-controlled trial. J Egypt Public Health Assoc 2016; 90:41-5. [PMID: 26154829 DOI: 10.1097/01.epx.0000464139.06374.a4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Oral and dental health is one of the most important aspects of public health, which becomes more important during pregnancy. Health education may effectively prevent a considerable percent of oral and dental diseases. OBJECTIVE This study was designed to evaluate the effects of an oral and dental health educational intervention during pregnancy on the beliefs and behaviors of pregnant women on oral and dental health. PARTICIPANTS AND METHODS In this randomized-controlled clinical trial, 160 pregnant women were allocated randomly to intervention and control groups (80 in each group). The intervention group received six education sessions over 3 weeks on oral health issues, whereas the control group received no education. Beliefs and behaviors of pregnant women on oral health were evaluated before, immediately, and 2 months after the educational intervention using a self-administered questionnaire containing 13 Likert scale belief statements and nine practice items. RESULTS There were no significant differences in the scores of behaviors between the two groups, whereas the scores of beliefs of the educated group were lower than the controls at baseline. The scores of beliefs and behaviors were significantly higher in the educated group than the controls immediately and 2 months after the education program (P<0.05). CONCLUSION AND RECOMMENDATIONS The results of the present study indicated the positive effects of oral health training during pregnancy in promoting the beliefs and behaviors of pregnant women on oral health. More attention to oral and dental education programs is recommended during pregnancy.
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Wagner Y, Heinrich-Weltzien R. Midwives' oral health recommendations for pregnant women, infants and young children: results of a nationwide survey in Germany. BMC Oral Health 2016; 16:36. [PMID: 26988101 PMCID: PMC4797163 DOI: 10.1186/s12903-016-0192-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 03/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies suggest that poor oral health during pregnancy can lead to perinatal complications, such as low birth weight and preterm delivery as well as poor oral health in children. Aim of this study was to assess the German midwives knowledge about oral health and preventive recommendations for pregnant women, infants and young children. METHODS The nationwide online-survey was conducted with use of a self-developed, pretested and validated standardized questionnaire. The German association of midwives (Deutscher Hebammenverband e.V.) informed their members about the survey through email, newsletter, website and association journal (Hebammenforum) (n = 7.500). Data were analyzed using descriptive statistics. RESULTS Response rate was 12.6 % (mean age 42.9 ± 9.3 years). The majority of midwives advised pregnant women about periodontal diseases (78.6 %). Of the midwives, 8.4 % mentioned the possible associations between periodontal diseases and perinatal complications. In general, half of the midwives (53.5 %) recommended a dental visit during pregnancy. A total of 65.5 % of midwives advised parents about early childhood caries. The majority of midwives recommended that oral hygiene starts with eruption of the first tooth (60.4 %) and the first dental visit of the child should be at age 2 or 3 years (51.6 %). Midwives recommendations regarding the implementation of oral hygiene and the referral to a dentist during pregnancy and childhood were highly variable. CONCLUSIONS To increase oral awareness and to improve the oral health knowledge among midwives and all other health-care professionals, uniform guidelines should be developed in Germany. TRIAL REGISTRATION German Clinical Trial Register DRKS00008021.
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Affiliation(s)
- Yvonne Wagner
- Department of Preventive Dentistry and Pediatric Dentistry, Jena University Hospital, Bachstr. 18, 07743 Jena, Germany
| | - Roswitha Heinrich-Weltzien
- Department of Preventive Dentistry and Pediatric Dentistry, Jena University Hospital, Bachstr. 18, 07743 Jena, Germany
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Heilbrunn-Lang AY, de Silva AM, Lang G, George A, Ridge A, Johnson M, Bhole S, Gilmour C. Midwives' perspectives of their ability to promote the oral health of pregnant women in Victoria, Australia. BMC Pregnancy Childbirth 2015; 15:110. [PMID: 25943399 PMCID: PMC4490712 DOI: 10.1186/s12884-015-0536-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 04/17/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Midwives have a potential role in promoting the oral health of pregnant women although they have little formal training in this area. The aim of this study was to explore the perspectives of midwives in Victoria towards incorporating oral health promotion into their antenatal practice after undergoing training through the Midwifery Initiated Oral Health (MIOH) online education program. METHODS A purposive sample of thirty-nine midwives from maternity services across Victoria, Australia were invited to participate in an online MIOH education program in October 2012. The program included three self-paced modules covering oral health screening, referral processes, and theoretical and practical skill assessments. A mixed methods design was used to capture midwives perspectives. Evaluation questionnaires, completed pre- and post-training, captured knowledge and confidence (confidence likert scale), and also included five opened-ended questions post-training. Open-ended questions, feedback forms and unsolicited emails formed the data for qualitative analysis. Data were analysed using content and thematic analysis and descriptive statistics. RESULTS Thirty-three midwives completed the MIOH education program and demonstrated a significant increase (51.5%) in their confidence to promote oral health. All participants viewed the program as suitable, acceptable and useful for their practice and were happy to recommend the course to other Victorian midwives. Participants indicated that it would be feasible to incorporate oral health into the first antenatal booking visit and recognised that oral health promotion was within their scope of practice. CONCLUSIONS This study has shown that the MIOH education program is a valued resource that can assist midwives to increase their confidence and skills to incorporate oral health promotion into their practice. A key barrier identified was time constraints during antenatal care booking visits. However, it is evident that with relevant training it would be feasible and acceptable for Victorian midwives to incorporate oral health promotion within their practice. The current engagement with midwives in Victoria and other parts of Australia provides an opportunity to continue to explore and define the role of antenatal health care professionals in oral health promotion at a state and national level.
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Affiliation(s)
- Adina Y Heilbrunn-Lang
- Centre for Applied Oral Health Research, Dental Health Services Victoria, Melbourne, Australia.
| | - Andrea M de Silva
- Centre for Applied Oral Health Research, Dental Health Services Victoria, Melbourne, Australia.
| | - Gillian Lang
- Health Promotion, Dental Health Services Victoria, Melbourne, Australia.
| | - Ajesh George
- Centre for Applied Nursing Research, University of Western Sydney/ South Western Sydney Local Health District, Sydney, Australia. .,Ingham Institute Applied Medical Research, Sydney, Australia. .,Faculty of Dentistry, University of Sydney, Sydney, Australia.
| | - Allison Ridge
- Health Promotion, Dental Health Services Victoria, Melbourne, Australia.
| | - Maree Johnson
- Faculty of Health Sciences, Australian Catholic University, Sydney, Australia.
| | - Sameer Bhole
- Faculty of Dentistry, University of Sydney, Sydney, Australia. .,Sydney Local Health District Oral Health Services and Sydney Dental Hospital, Sydney, Australia.
| | - Carole Gilmour
- Australian College of Midwifery Victorian Branch, Melbourne, Australia. .,Monash University, Melbourne, Australia.
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