Managing dental caries in children in Turkey--a discussion paper

Efficacy of non-instrumental Endodontic treatment in primary teeth: a systematic review of clinical randomized trials

BACKGROUND

Endodontic therapy in pediatric dentistry is a challenging procedure, especially for special needs, uncooperative, and very young patients. A new conservative approach which is the non-instrumental endodontic treatment (NIET) has been developed to simplify the management of primary teeth requiring pulpectomy. This review aimed to compare the efficiency of NIET and conventional endodontic treatment in primary teeth.

METHODS

Electronic databases including MEDLINE (via PubMed), Cochrane Library (CENTRAL), and Scopus without restrictions on publication year or publication language were searched. Only randomized clinical trials reporting clinical and radiographical outcomes of NIET and conventional pulpectomy on primary teeth were considered eligible. Two reviewers extracted the data according to the PRISMA statement and assessed the bias risk using the revised Cochrane risk-of-bias tool and a meta-analysis was performed.

RESULTS

From 3322 screened articles, seven articles meeting the inclusion criteria were included. The selected studies included 283 primary molars, of 213 children aged between 3 and 9 years, treated by NIET and conventional pulpectomy, and had follow-up periods ranging from 1 month to tooth exfoliation. Two studies reported good success rates for both the NIET technique and endodontic therapy with no statistically significant difference while three studies showed radiographical significant differences with a low success rate for the NIET technique. Only one study reported better outcomes in the pulpectomy group with statistically significant differences. The quantitative grouping of the included studies showed no significant differences between NIET and conventional endodontic therapy regarding clinical and radiographical success (p value > 0.05).

CONCLUSION

No difference between the NIET technique and the conventional endodontic therapy in primary molars requiring pulpectomy could be confirmed. Results of the present review need to be interpreted with caution since the quality of evidence according to the GRADE was considered as moderate to very low. Therefore, additional clinical trials on the NIET technique are recommended.

Does Efficiency of Oral and Dental Health Centers Change by the Development Level of Regions?

OBJECTIVES

This study aimed to analyze the efficiency levels of oral and dental health centers (ODHCs) affiliated to the Ministry of Health from the perspective of the development levels in the regions.

METHODS

Within the framework of this study, the efficiencies of 127 ODHCs are evaluated with the data envelopment analysis based on Charnes, Cooper, Rhodes (CCR); Banker, Charnes, Cooper (BCC); and scale efficiency methods.

RESULTS

It is found that CCR, BCC, and scale efficiencies of the 42 ODHCs located in the first region, the highest development region, are efficient by 31%, 50%, and 38% whereas 13%, 26%, and 26% of other 85 ODHCs located in other regions are efficient, respectively. Additionally, the average efficiency scores of 42 ODHCs in the first region by CCR (0.82), BCC (0.89), and score efficiency (0.93) are much higher than the average efficiency scores of 85 ODHCs in other regions by CCR (0.73), BCC (0.80), and scale efficiency (0.92).

CONCLUSIONS

According to the findings, it is considered that the individuals from the first region use the oral and dental healthcare more than the individuals do in other regions because the access to oral and dental healthcare is higher in the first region and the individuals living in this region have better predisposing and enabling factors. The study results are thought to present evidence-based information to health policy makers regarding the regional planning of oral and dental healthcare.

Development of Valid and Reliable Tools for Pediatricians' Knowledge and Self-Perceived Competency Towards Oral Health of Children in Turkey

Background

This study aimed to develop a valid and reliable questionnaire of knowledge about oral health in childhood and a scale of self-perceived competency for pediatricians. In this way, the contributions of Turkish pediatricians on oral health in childhood and their effects on children's oral health and caregivers will be evaluated.

Subjects and Methods

Items were generated from published scientific literature, other questionnaires, and interviewing notes with the pedodontists. The study group examined publications on the preventive oral health of children, and they included items related to children in the item pool. The initial knowledge questionnaire consisted of 23 items and 10 items for the self-perceived competency scale. The content validity of the questionnaire and scale were determined by the assessments of the expert team. The internal consistency of the knowledge questionnaire and test-retest reliability of the self-perceived competency scale was examined.

Results

Thirty pediatricians took part in the study. The pediatricians were: 63.3% (n = 19) female and 36.7% (n = 11) male; their mean age was 37.97 ± 3.86 years. Most of the pediatricians were specialists with 83.4% (n = 25). The medical specialization of all pediatricians was university and the working year mean was 10.93 ± 4.28. The knowledge questionnaire had 10 items after content validity and internal consistency reliability investigations. The initial number of items for the self-perception level scale was 10. We excluded five items due to the content validity index. ICC value for 5-item self-perception level scale was calculated as 0.816 (95% CI: 0.606-0.914). Therefore, the scale has a good reliability level.

Conclusion

Our knowledge questionnaire and self-perceived competency scale provide a validated and reliable tool in the assessment of pediatricians' knowledge and competency regarding oral health. Pediatricians can test themselves using this knowledge questionnaire and self-perceived competency scale.

Dental caries severity and related factors of 1307 Turkish boarding school children

Background

In Turkey, dental caries is a disease which still has been considering as a real public health problem. School children of lower socioeconomic status had greater caries experience and higher caries severity in both primary and permanent dentitions.

Aims

To determine the frequency of dental caries and its related factors among boarding school children.

Patients and Methods

Cross-sectional study. We examined 1307 boarding school children aged 7-14 for caries status and its related factors. Data on dental health and its related factors were obtained from the archive of Ege Oral Health and Dentistry Association. Comparisons of caries severity (as decayed/missing/filled primary teeth, dmft/decayed/missing/filled permanent teeth, DMFT and significant caries index,) and examination years were made. Caries trend were also identified. Correlations between caries severity and its related factors were also performed. SPSS 20.0 was used for statistical analysis.

Results

DMFT and SiC for DMFT of all children were 2.35 and 5.04, respectively. 70-year-old had the highest dmft, whereas 14-year-olds had the highest DMFT. No correlation was found between decreased dmft and tooth brushing frequency, regular dental check-ups, and oral hygiene status. There was a weak correlation between decreased DMFT and increased number of dental visits in 2008 and 2009. In children received more than one examination and/or treatment (n = 269), the SiC index for dmft was 10.52 in 2002. In 2004, the index decreased to 3.57. The SiC for DMFT was 4.09 in 2002 and 2004. No correlation was identified between decreased dmft and DMFT and tooth brushing frequency, regular dental check-ups, and oral hygiene status both for the years of 2002 and 2004. The mean dmft of 32 children had prophylaxis for dental caries in 2002 was significantly decreased in 2004.

Conclusion

Caries prevalence and severity of boarding school children were high even they were followed-up regularly.

Self-awareness of X, Y, and Z generations for dental health: A comparative clinical study

Background and Aim

Generation defines as a group of people who were born in a same interval of year and shares similar life events at critical developmental stages, values, behaviors, and significant reactions. The aim of this clinical study was to assess self-awareness of dental health of X, Y, and Z generations in Turkey.

Materials and Methods

Total of 239 individuals were divided into three homogenous groups X Generation (X Gen; n = 80), Y Generation (Y Gen; n = 80), and Z Generation (Z Gen; n = 79) by their date of birth 1965-1980; 1981-2000; 2001-2013, respectively. Self-rated caries status, frequency of tooth brushing, frequency of dental visits, and actual caries status were recorded. Self-awareness was calculated as the extraction of the numbers of actual caries and self-rated caries and coded as △ Caries.

Results

Mean Dental caries status was recorded using the number of decayed, missing or filled teeth (dft/DMFT) was 4.92 for X Gen; 4.68 for Y Gen; 3.66/3.51 for Z Gen individuals, respectively. Actual caries and self-rated caries were significantly incompatible with each other in all study groups (<0.001). △Caries were insignificant in X, Y, and Z Generations (>0.05); nevertheless, self-awareness (self-rated caries = actual caries) of Z Gen were found numerically more (23%) compared to other groups. Tooth-brushing habits of all individuals were mostly once-a-day (>0.05). Mean frequency of dental visits were once in a 3.5; 2.9; 1.5 years for X, Y, and Z Gens, respectively.

Conclusion

There is no significant correlation between frequency of dental visits and self-awareness measures. Oral health education should urgently point out for all generations by dental professionals, media, and governmental authorities including preventive methods, oral hygiene instructions all aimed at preventing caries and raising self-awareness.

Varying Manpower Alters Dental Health in a Developing Health Care System

OBJECTIVES

This study assessed relationships between oral health care workforce and dental health in 12-year-olds in a developing health care system in Iran from 1992 to 2014 and compared these findings with the most recent corresponding findings in selected countries.

METHODS

Data regarding oral health care workers from 1962 to 2014 were extracted from the comprehensive human resource data bank of the Shahid Beheshti Research Institute of Dental Sciences. Data regarding decayed, missing, and filled permanent teeth (DMFT) of 12-year-olds, extracted from official statistics, described dental health. Comparisons with other countries utilised the database of the World Health Organization. Changes in the DMFT index with fluctuations in the number of oral health care workers were investigated using exploratory data analysis methods. Associations of DMFT with the density of the oral health care workforce were evaluated using a multiple linear regression model.

RESULTS

The trend in supply of dental workforce in Iran began to expand in the 1970s and, after a reduction in 2003 to 2007, reached a peak by 2014. Means of DMFT indices of 12-year-olds in Iran fluctuated between 1.50 and 2.40 from 1992 to 2014. The relationship between the dentist to population ratio and the DMFT index of 12-year-olds showed a downwards trend (r = -0.994; P < .001) until 1998 and afterwards an upwards trend (r = 0.887; P < .001). Globally, the DMFT index decreased in countries with a preventively-oriented oral health care workforce.

CONCLUSIONS

Increased numbers of dentists have no significant impact on improving dental health in 12-year-olds. To promote dental health, the system providing health services should implement a preventively-oriented approach when planning for the oral health workforce.

ATTITUDES TOWARDS AND HABITS IN ORAL HEALTH OF ADOLESCENTS IN HERZEGOVINA

The aim of the study was to determine attitudes towards and habits in oral health of adolescents in Herzegovina, as well as to evaluate the possible differences in habits among individuals of different adolescent categories. The study included 120 participants (35 male and 85 female) divided into three adolescent categories, as follows: early (11-14 years of age), middle (15-18 years) and late (19-21 years) adolescence, from the Herzegovina-Neretva Canton, who presented for dental examination. All participants completed the socio-demographic questionnaire and standardized Hiroshima University Dental Behavioral Inventory (HU-DBI). The answers provided by study adolescents in the HU-DBI showed statistically significant differences among particular age groups, i.e. between early and middle adolescence in items 7 (p=0.046) and 15 (p=0.007); between middle and late adolescence in items 8 (p=0.021), 11 (p=0.04) and 12 (p=0.027); and between middle and late adolescence in item 11 (p=0.032). Respondents in middle adolescence had poorer oral hygiene attitudes than those in early and late adolescence. In order to improve the oral hygiene habits of adolescents in Herzegovina, it is necessary to put emphasis on continuous education about oral hygiene habits during their secondary education.

Oral health status of children and young adults with maple syrup urine disease in Turkey

Background

Maple syrup urine disease (MSUD) is an inherited disorder clinically characterized by ketoacidosis, seizures, coma, psychomotor delay, and intellectual disability. The treatment requires a life-long protein-restricted diet, rich in carbohydrates and fats, supplemented with a medical amino acid formula. Diet, oral health and general health influence each other in a vicious cycle. The aim of this study was to investigate the oral health status of children and young adults with MSUD in Turkey.

Methods

A descriptive study was conducted on patients with MSUD who applied for routine follow-up to the pediatric metabolic diseases clinic at Hacettepe University, Children's Hospital in Ankara, Turkey in a 12-month period. Patients with any other concomitant genetic diseases and acute infection were excluded. A total of twenty-five patients were enrolled and underwent oral examination including DMFT/S, dmft/s (decayed/missing/filled teeth/surfaces for deciduous and primary teeth, respectively), plaque and gingival indices. Panoramic radiographs were obtained in 12 cooperative patients.

Results

Mean age was 9.88 ± 5.68 s.d years. More than half of the parents had only primary school level education, and low income. Fourteen patients consumed medical formula during or right before sleep. Fourteen patients reported caries-associated pain. Gingival inflammation was present in all 15 patients who cooperated for evaluation. Seven out of twelve patients had at least one dental anomaly or alterations in mandibular morphology. Five patients had previously been treated for caries under general anesthesia. To our knowledge, this is the first study to document oral clinical and radiologic findings in patients with MSUD.

Conclusions

Impaired oral health was observed in this rare disease population. Regular dental referral by physicians, preventive measures and dental treatments should be included in multidisciplinary management of maple syrup urine disease to promote oral health.

Psychometric evaluation of the child oral impacts on daily performances (C-OIDP) for use in Turkish primary school children: a cross sectional validation study

BACKGROUND

As patient-reported outcome, the Child Oral Impacts on Daily Performances (C-OIDP) has been commonly used for assessing children's oral health needs in order to facilitate oral health service planning. It was translated and cross-culturally adapted into Turkish in 2008. Since then, there is no study to assess its psychometric properties in Turkish child population. This cross-sectional study aimed to investigate the psychometric properties and factor structure of the Turkish version of the C-OIDP for use in Turkish primary school children.

METHODS

The Turkish translated version was tested on a convenience sample of primary school children aged 11 to 12 years attending two public schools in Istanbul. Data were collected by clinical examinations, face-to-face interviews and self-completed questionnaires. The internal consistency, test-retest reliability, construct validity using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), criterion related validity (concurrent and discriminant) were evaluated.

RESULTS

A total of 208 children were subjected to the tested the C-OIDP. Overall, 93.7% of them reported at least one oral impact in the last 3 months. The most frequently affected performances were "eating" (72.1%) and "cleaning mouth", while the performance with the lowest impact was "studying" (13%). The internal consistency and reproducibility of the C-OIDP were acceptable, with a Cronbach's alpha of 0.73 and an intra-class correlation coefficient of 0.83. The EFA yielded a two-factor model termed "functional limitation" and "psychosocial limitation". CFA identified the two- factor model which fit the data better than the previously proposed three-factor model, namely physical, psychological and social health. Having malocclusion, the presence of gum disease, reported history of oral problems in the mouth, dissatisfaction with oral health, bad self-rated oral health and having a problem-oriented pattern of dental attendance were found to be the most important factors related to worse oral health- related quality of life, supporting its criterion-related validity.

CONCLUSION

This study provided preliminary evidence the psychometric properties of the C-OIDP index among Turkish school children aged 11-12 years. It may be applied to evaluate the oral health impact on quality of life in this population.

Evaluation of Final-Year Turkish Dental Students' Knowledge, Attitude, and Self-Perceived Competency towards Preventive Dentistry

BACKGROUND

Dental education plays an important role in providing students with the opportunity to develop their evidence-based knowledge and clinical skills regarding patient-specific preventive care and caries management strategies. The aims of this study were to examine the knowledge, attitude, and self-perceived competency towards preventive dentistry among final-year dental students and to investigate their preventive practice for high-caries-risk children. Methods. Data were collected from a convenience sample of 126 dental students using a questionnaire. The IBM SPSS Statistics version 21 was used for data analysis.

RESULTS

A total of 126 students completed the questionnaire, and 63% of the respondents were female. Significant gender differences were found in the total Professional Preventive Knowledge Scale (PPKS) (p=0.016) and its subscales of the noncariogenic nutrition (p=0.015), dental hygiene/clinical examination (p < 0.001), caries-preventive practice (p=0.02), and the Hiroshima University-Dental Behavioral Inventory (HU-DBI) (p=0.028). Significant differences were observed in the total PPKS (p=0.003) and its subscales of the noncariogenic nutrition (p=0.043) and caries risk management (p=0.006) in terms of self-perceived need to receive education and training. Caries-preventive practice was correlated with the self-perceived competency (r = 0.279; p=0.002), the attitudes (r = 0.394; p < 0.001), the total PPKS (r = 0.457; p < 0.001) and its all subscales of dental hygiene and clinical examination (r = 0.425; p < 0.001), noncariogenic nutrition (r = 0.410; p < 0.001), and caries risk management (r = 0.184; p=0.039). The self-perceived competency was positively correlated with the total PPKS (r = 0.192; p=0.031) and its subscale of noncariogenic nutrition (r = 0.259; p=0.003). Greater self-perceived competence, more positive attitudes, and good knowledge regarding preventive dentistry were found to be important predictors of the caries-preventive practice of dental students, explaining 31% of the variance (adjusted R ² = 0.312, p < 0.001).

CONCLUSION

40% of dental students reported educational and training needs regarding the diagnosis, caries-preventive agents, and risk-based treatment plan. These results should be taken into account by the stakeholders in developing the national core curriculum for undergraduate Turkish dental education.

Comparison of Two School-Based Oral Health Education Programs in 9-Year-Old Children

This study evaluated the effectiveness of two school-based oral health education (OHE) programs on the oral health knowledge and behavior and oral hygiene of 9-year-old children in Turkey. The study included 1,053 school children aged 9 years in Aydin, Turkey. This study was a prospective, two-arm, and parallel-group clinical trial between two different OHE programs. The dentist group received one lecture on OHE given by dentists in the classroom. The teacher group had a similar lecture given by school teachers, including supporting materials which were available throughout the academic year. Oral health knowledge and behavior were evaluated with a questionnaire at baseline, and then at 1 and 6 months. In total, 110 students were randomly selected to undergo a plaque accumulation assessment according to the Silness-Löe Index at baseline and 1 month later to determine the effects of the education programs on oral hygiene. At baseline, tooth-brushing frequency was similar in the study groups. Compared with baseline, the frequency of brushing increased significantly after 1 and 6 months in both groups ( p < .001). Teacher education was more effective for teaching correct brushing techniques ( p < .001). A significant decrease in plaque accumulation has been evaluated in both study groups at the 1-month examination after the education session ( p < .05). Both OHE programs were found to generate improvements in knowledge and behavior of children on oral health and plaque control in the short term.

Modern management of dental decay in children and adolescents - a review

Health is a right that requires responsible individual actions. Oral health corresponds to an important part of general health, even if for a large majority of people healthy teeth are equal with beautiful teeth. For children and adolescents "having an attractive smile" is synonymous with social acceptance and success. Dental decay has a high incidence in children in our country and progress in decay prevention, diagnosis and treatment is not reflected in children and adolescents' oral health. It is established by studies conducted by dentists and psychologists that dental decay can affect the quality of life by engendering specific eating behaviors, particular ways of speech or smile and unfortunately pain. The aim of this article is to emphasize the modern approach of dental decay in line with principles of non-invasive strategies. An important element to be considered - prophylactic methods - must be included in every treatment plan, in order to control individual caries risk. The time invested in prevention during childhood represents a real benefit for the future adult's oral health. Many a dental problems can be avoided if dental decay management relies on the link between medical science and every day practice.

The role of parental education and socioeconomic status in dental caries prevention among Lithuanian children

BACKGROUND AND OBJECTIVE

The aim of this study was to disclose parental attitudes toward their children's dental care and preventive measures used as well as to evaluate their associations with parental education and socioeconomic status.

MATERIALS AND METHODS

A total of 1248 parents of 7-, 9-, and 12-year-old children from 5 largest Lithuanian cities were enrolled in the study. The questionnaire comprised 34 items, which were grouped into 4 clusters.

RESULTS

The parents with a high educational level scored better than those who had a low educational level (2.13 [SD, 0.39] vs. 2.2 [0.43], P=0.002). The parents who reported sufficient-family income scored their child's and their own health significantly better than those reporting insufficient-family income (2.02 [SD, 0.37] vs. 2.27 [SD, 0.41], P<0.001). The parents cared about their child's health more than about their own (1.53 [SD, 0.51] vs. 2.15 [0.61], P<0.001). The parents with a high educational level and those receiving sufficient income cared about education on oral hygiene and regular preventive dental check-ups more than those with a low educational level and insufficient income (36.7% and 40.8% vs. 30.2% and 28.7%, P<0.01 and P<0.001, respectively). The children whose parents had a high educational level brushed their teeth 2 times a day more frequently than those of the parents with a low educational level (48.5% and 42.4%, respectively, P<0.001).

CONCLUSIONS

Greater attention to children's dental care as well as keeping their teeth healthy was paid by the parents with a high educational level and sufficient income.

Water fluoridation: a critical review of the physiological effects of ingested fluoride as a public health intervention

Fluorine is the world's 13th most abundant element and constitutes 0.08% of the Earth crust. It has the highest electronegativity of all elements. Fluoride is widely distributed in the environment, occurring in the air, soils, rocks, and water. Although fluoride is used industrially in a fluorine compound, the manufacture of ceramics, pesticides, aerosol propellants, refrigerants, glassware, and Teflon cookware, it is a generally unwanted byproduct of aluminium, fertilizer, and iron ore manufacture. The medicinal use of fluorides for the prevention of dental caries began in January 1945 when community water supplies in Grand Rapids, United States, were fluoridated to a level of 1 ppm as a dental caries prevention measure. However, water fluoridation remains a controversial public health measure. This paper reviews the human health effects of fluoride. The authors conclude that available evidence suggests that fluoride has a potential to cause major adverse human health problems, while having only a modest dental caries prevention effect. As part of efforts to reduce hazardous fluoride ingestion, the practice of artificial water fluoridation should be reconsidered globally, while industrial safety measures need to be tightened in order to reduce unethical discharge of fluoride compounds into the environment. Public health approaches for global dental caries reduction that do not involve systemic ingestion of fluoride are urgently needed.

Oral health behavior of parents as a predictor of oral health status of their children

Introduction. It is widely acknowledged that the behavior of parents affects their children's health. This study aimed to evaluate the relationship between oral health behavior of parents and oral health status and behavior of their children in a sample of preschool children in Iran. Method and Material. A random sample of over-five-year-old preschool children and their parents were enrolled in the study. Selection of schools was by clustering method. Parents were asked to fill a piloted questionnaire which included demographic characteristics, socioeconomic status, oral health behaviors of children and their parents. Oral health status of children was examined. The parent and their children oral health relationship were tested using regression and correlation analysis. Results. About 222 parents and children participated in the study. There was a significant relationship between history of having dental problems in parents and dmft index in their children (P = 0.01). There was a significant relationship between parental frequency of tooth brushing and child frequency of tooth brushing (P = 0.05); however, there was no significant relationship between parental frequency of dental visits and those of their children (P = 0.1). Conclusion. The study concluded that some important health behaviors in parents, such as tooth brushing habits are important determinants of these behaviors in their young children. So promoting parent knowledge and attitude could affect their children oral health behavior and status.

Survival rate of approximal-ART restorations using a two-layer technique for glass ionomer insertion

OBJECTIVE

Good survival rates (SR) have been reported for occlusal-atraumatic restorative treatment (ART) restorations but not for approximal-ART restorations. The high-viscosity consistency of the glass ionomer cement (GIC) may lead to its incorrect adaptation into the cavity and thus to failure of the restoration. Because the use of a flowable GIC layer seemed to improve its adaptation in approximal restorations in vitro, we evaluated whether the use of an intermediate flowable GIC layer would improve the SR of approximal-ART restorations.

METHODS

A total of 208 children (6-7 years old) with at least one occluso-proximal carious lesion in a primary molar were selected and randomly allocated to two groups: G1, conventional technique, one-layer GIC (powder/liquid ratio 1:1); and G2, two-layer technique, consisting of a first layer of GIC with a flowable consistency (powder/liquid ratio 1:2) and a second layer of a regular consistency. Restorations were made by final-year students and evaluated after 1, 6, 12 and 18 months. Restoration survival was evaluated using Kaplan-Meier survival and logrank test. Poisson regression analyses (α = 5) were used to verify the influence of factors such as insertion technique, restoration surface and operators.

RESULTS

The overall SR of the restorations after 18 months was 68 %. There was no difference in SR between the techniques, neither did the other factors influence the SR.

CONCLUSIONS

Over 18 months, the use of an intermediate flowable GIC layer in approximal-ART restorations does not improve the restoration survival.

CLINICAL RELEVANCE

This study suggests that the two-layer technique is not the answer for increasing approximal-ART restoration longevity.

Cross - cultural adaptation and preliminary validation of the Turkish version of the early childhood oral health impact scale among 5-6-year-old children

Background

In Turkey, formal pre-primary education for children 5- 6 years old provides the ideal setting for school-based oral health promotion programs and oral health care services. To develop effective oral health promotion programs, there is a need to assess this target group's subjective oral health needs as well as clinical needs. The Early Childhood Oral Health Impact Scale (ECOHIS) is a well-known instrument for assessing oral health quality of life in children aged 0-5 years old and their families. This study aimed to adapt the ECOHIS for children 5-6 years old in a Turkish-speaking community and to undertake a preliminary investigation of its psychometric properties.

Methods

The Turkish version of the ECOHIS was obtained with forward/backward translations, expert panels and pre-testing and it was tested in a convenience sample of 121 parents of 5- 6 year-old children attending nursery classes of three public schools. Data were collected through clinical examinations and self-completed questionnaires. The main analyses were carried out on the imputed data set. The validity of content, face, construct, discriminant and convergent and as well as the reliability of internal and test-retest of the ECOHIS were evaluated. Sensitivity analysis was performed to examine the effect of the complete case analysis for managing "Don't know" responses on the validity and reliability of the ECOHIS.

Results

The analysis of the imputed data set showed that Cronbach's alphas for the child and family sections were 0.92 and 0.84 respectively, and for the whole scale was 0.93. The intraclass correlation coefficient for test-retest was 0.86. The scale scores on the child and parent sections indicating worse quality of life were significantly associated with poor parental ratings of their child's oral health, high caries experience, higher gingival index scores and problem-orientated dental attendance, supporting its construct, convergent and discriminant validity. Sensitivity analysis showed that the mean imputation method and the complete case analysis did not have differing effects on the validity and reliability of the ECOHIS.

Conclusions

This study provided preliminary evidence concerning validity and reliability of the Turkish version of the scale among 5-6-year-old children. Future studies should be conducted on the ECOHIS to evaluate fully its psychometric properties in both community- based and clinically-based studies among parents of children younger than five. This study provides initial evidence that the ECOHIS aimed at children aged 0-5 years may be a useful tool for assessing the oral health quality of life in 6 year - old preschool children.

Oral health: locus of control, health behavior, self-rated oral health and socio-demographic factors in Istanbul adults

OBJECTIVES

To determine oral health control beliefs of Istanbul adults using the Multidimensional Oral Health Locus of Control Scale (MOHLCS) after confirming its factorial validity and to examine the relationships between these beliefs, self-rated oral health, oral health behaviors and socio-demographic factors.

MATERIAL AND METHODS

The MOHLCS was administered to a sample of 1200 subjects aged ≥18 years in Istanbul chosen using a quota-sampling method (response 88%). The relationship between the MOHLCS and oral health behaviors, self-rated oral health and socio-demographic factors was assessed after confirming the factorial validity of the MOHLCS.

RESULTS

The MOHLCS demonstrated satisfactory internal reliability. Factor analysis results showed a new four-factor solution, namely Internal, Dentist, Chance, and Socialization agents. Multivariate analysis showed that female gender, younger age, higher socioeconomic status, more frequent daily toothbrushing, and regular dental check-ups were associated with higher Internal beliefs, while older age, lower educational level, lower socioeconomic status, low toothbrushing frequency, and symptom-orientated dental attendance were associated with higher Chance beliefs. Being unmarried and low toothbrushing frequency were associated with lower Dentist beliefs. Males and older subjects had lower Socialization agents beliefs. Internal, Dentist and Chance beliefs were significantly associated with self-rated oral health.

CONCLUSIONS

Compared with the original factor structure, the new factor structure had better goodness of fit for this sample. Self-rated oral health, socio-demographic factors, and oral health behaviors were significantly associated with oral health control beliefs. These beliefs may be useful for planning oral health promotion programs and for formulating advice given by oral health professionals about their patients' oral health behaviors.