The dentist's role in promoting community water fluoridation: a call to action for dentists and educators

Community water fluoridation and the integrity of equitable public health infrastructure

Community water fluoridation is a population health program that is in a unique position to equitably prevent dental caries across all socioeconomic groups. A review of the 76‐year long history of community water fluoridation shows that the challenges to expanding this program persist despite continued evidence of its efficacy. We offer dental health practitioners an opportunity to share the evidence of this oral disease prevention program with the communities they serve. While dental caries is still the most prevalent chronic disease that disproportionately effects lower socioeconomic status communities, community water fluoridation continues to decrease cavities by 25% at the population level. COVID‐19 has reaffirmed the importance of disease prevention and valuing public health infrastructure. There is a continued need for community water fluoridation to offer equitable access to oral disease prevention interventions.

COVID-19 Perceptional Disparity Among Dental Healthcare Personnel at King Faisal University: Applying Health Belief Model

Objectives  In Saudi Arabia, more than 100, 000 cases of COVID-19 have been reported, and more than 4,000 in Al Hofuf to date. Dental healthcare personnel are at a higher risk of COVID-19 due to their exposure to saliva, blood, and aerosol/droplet during their daily practice. Their perceptions of COVID-19 drive their behaviors.

Materials and Methods  A cross-sectional online survey to assess COVID-19 related perceptions and possible disparities between them.

Statistical analysis  Data were analyzed using the Statistical Package for the Social Science, version 23 (IBM SPSS). Descriptive analyses were performed using frequencies and percentages for categorical variables, mean and (± SD) for numerical variables. Bivariate analyses were assessed using t -test and one-way ANOVA, with a 95% confidence interval (CI).

Results  With a response of 75% (150), results showed that there were perceptional disparities: students and technical staff perceived more barriers to preventive measures compared to faculties with a mean difference of (−0.145 SD ± 0.580, p = 0.802, CI −1.29 / 1.00 and −2.433, SD ± 0.94, p = 0.010), respectively. This was also shown in threat perception with a mean difference of (2.525, SE ± 0.917, CI 0.71/4.34, p = 0. 0.007). Students perceived more threat than clerks did with a mean difference of (1.281, SE ± 0.569, CI − 0.16 / 2.41, p = 0.026), while clerks perceived less threat than the technical staff with a mean difference of (−2.790, SE ± 0.860, CI −4.49 /−1.09, p = 0.001).

Conclusions  There was a clear disparity in the perceptions among the different categories of participants. More emphasis on the training and preparedness of the dental healthcare personnel is required.

Introducing legislative advocacy into the dental school curriculum: A mixed-methods evaluation

The aim of this project was to evaluate a legislative advocacy exercise in pediatric dentistry at 1 North American dental school. A mixed-methods approach was employed using focus groups and questionnaires. All third-year dental students (n = 84) participated in an exercise as part of the pediatric dentistry course. Participation in the program evaluation was voluntary. Questionnaires were administered to assess students' advocacy beliefs, behaviors, self-efficacy, and knowledge 1 week before and 1 week after the exercise. Six months later, a focus group with questionnaire non-respondents (n = 9) was conducted to explore participants' attitudes and beliefs about oral health advocacy within the dental school curriculum. The focus group followed a semi-structured guide, and transcripts were analyzed using thematic content analysis. Questionnaires were returned from 27 students before (33% response rate) and 23 students (28% response rate) following the advocacy exercise. Students' advocacy beliefs, behaviors, and knowledge showed no change, whereas self-efficacy improved following the advocacy exercise. Students enjoyed the advocacy exercise and viewed it as a positive addition to the curriculum; however, they requested more exposure to advocacy across the curriculum. Students described the power of their collective voice rather than a single person as a major driver of policy change. These findings suggest that curricular changes should incorporate experiential advocacy activities more frequently to help students learn about and gain advocacy skills.

Pediatric dentists who accept new Medicaid-enrolled children report higher willingness to advocate for community water Fluoridation

BACKGROUND

Dentists, who advocate for Community Water Fluoridation (CWF), can help decrease the dental caries disparity gap between low and high socioeconomic groups. Advocating for CWF, a cause that promotes oral health at the population level is an altruistic behavior. Dentists who accept and provide services to Medicaid-insured children, who are from low socioeconomic backgrounds, are also considered altruistic. We tested the association between accepting new Medicaid-insured children every month, and willingness to advocate for CWF programs in pediatric dentists (PDs).

METHODS

In 2016, a 22-item pilot tested online survey was sent to 5394 PD members of the American Academy of Pediatric Dentistry. Descriptive analysis and a multiple adjusted logistic regression model was conducted.

RESULTS

Dentists who accept new Medicaid-insured children every month (OR: 1.62; 95% CI: 1.06-2.47; p = 0.02) were more willing to advocate for CWF compared to their counterparts. Those practicing primarily in rural (OR = 4.67; 95% CI: 1.82-11.9; p = 0.001), and urban areas (OR = 2.27; 95%CI: 1.05-4.89; p = 0.04), and those willing to promote fluoridated water consumption to parents in the clinic (OR = 3.40; 95% CI: 1.87-6.21; p = < 0.0001) were significantly more likely to be willing to advocate for CWF. PDs trained in public health advocacy during pediatric residency alone (OR = 2.37; 95% CI: 1.24-4.51; p = 0.009), or during both pre-doctoral dental education and pediatric residency (OR = 3.51; 95% CI: 1.87-5.6; p = < 0.0001) were more willing to advocate for CWF compared to their counterparts.

CONCLUSIONS

PDs who accepted new Medicaid-insured children every month were more willing to advocate for CWF programs compared to those who did not.

Surveying Dentists' Perceptions of Caregiver Refusal of Topical Fluoride

The objective of this study was to assess dentists' perceptions of caregiver topical fluoride refusal behaviors. We administered an 8-item survey in 2015 and 2016 ( N = 582) and asked dentists about the extent to which fluoride refusal is a problem, refusal trends, comfort talking to caregivers who refuse, and perceived reasons why caregivers refuse. To examine geographic variation, we ran χ² tests between dentists' location (US West vs. non-West) and the first 3 perception measures (α = 0.05). Nearly 80% of dentists believed fluoride refusal was a problem, and 42.3% believed it was a growing problem. A significantly larger proportion of dentists who saw fluoride refusal as a problem also believed refusal was a growing problem compared to those who thought refusal was not a problem (89.6% and 41.2%, respectively; P < 0.0001). Caregiver characteristics perceived to be associated with fluoride refusal included immunization refusal (41.3%), White race (37.6%), and high income (33.7%). Thirty-seven percent of surveyed dentists were uncomfortable talking to caregivers who refused. There were no geographic differences in perceptions of fluoride refusal as a problem ( P = 0.52). A significantly larger proportion of non-West dentists believed fluoride refusal has gotten worse (non-West: 65.5%, West: 41.2%; P < 0.0001), but more dentists from the West were uncomfortable talking to caregivers who refused (West: 86%, non-West: 67.4%; P < 0.0001). Caregiver refusal of topical fluoride may be a growing problem, and many dentists are uncomfortable talking to caregivers who refuse. Additional interdisciplinary research is needed to identify the reasons why caregivers refuse fluoride, which is an important next step in developing chairside interventions that address fluoride refusal behaviors. Knowledge Transfer Statement: The results of this study can be used by researchers to develop chairside strategies to help dentists identify and manage fluoride refusal behaviors in clinical settings. This could help preserve topical fluoride as an evidence-based preventive therapy and address a growing public health problem.

Parental perception of fluoridated tap water

PURPOSE

The purpose of this study was to investigate parental knowledge and preference of tap water in a country where faucet water is fluoridated according to international standards and where the average percentage of dental caries in young children reaches up to approximately 73%.

MATERIALS AND METHODS

A cross-sectional perspective study was conducted at Hamad Medical Corporation, the only tertiary care and academic hospital in the state of Qatar. Parents of children older than 1 year of age were offered an interview survey.

RESULTS

A total of 200 questionnaires were completed (response rate = 100%). The mean age of participant children was 6 ± 4 years. One of the main finding in our study was that primary care physicians never discussed the topic of the best water choice for children in our community, as expressed by more than 86% of parents. More than two-third of parents used bottled water. The main concerns of why parents did not allow their children to drink tap water were taste (8.94%), smell (9.76%), concerns of toxins content (32.52%), and concerns that tap water might cause unspecified sickness (52.03%). Amid revealing participants that our tap water is safe and that fluorine can prevent dental caries, 33% of parents would you use tap water due to its fluoride content. The study also showed that 65% of parents would allow their children to drink tap water if it is free from any toxic ingredients.

CONCLUSION

Actions to augment fluoridated water acceptability in the developing world, such as focusing on safety and benefits, could be important in the disseminated implementation of the use of faucet water. Ultimately, a slump in the prevalence of dental caries among children will depend on the ability of pediatricians and dental professionals to institute evidence-based and preventive approach that can benefit oral health in childhood. These data will also allow us to propose the use of tap water safely in young children in the state of Qatar while simultaneously advocating awareness of oral health.

Effect of Advocacy Training During Dental Education on Pediatric Dentists' Interest in Advocating for Community Water Fluoridation

Dentists, like other health professionals, are uniquely positioned to be public health advocates. One venue where dental students can become skilled public health advocates is in dental education programs. However, debates about the need and importance of integrating advocacy training into dental curricula exist. Therefore, the aim of this study was to assess the association between pediatric dentists' interest in and willingness to participate in an advocacy-related activity and their prior training in advocacy during dental education. The advocacy activity used in the study related to community water fluoridation (CWF). A 22-item pilot-tested online survey was sent in February-May 2016 to 5,394 pediatric dentists who were members of the American Academy of Pediatric Dentistry. The final response rate was 16% (n=830). Most (77%) of the respondents were willing to advocate for CWF initiatives at the community and/or state levels. Only 44% of the respondents reported receiving training in advocacy during their predoctoral dental and/or pediatric dental residency education. The pediatric dentists who were willing to advocate for CWF initiatives had 2.7 times (95% CI: 1.63-4.39, p<0.0001) the odds of having received advocacy training during their dental education compared to those who were unwilling. These results suggest a positive association between the pediatric dentists' willingness to advocate for CWF and their prior advocacy training during dental education. This finding provides support for the Commission on Dental Accreditation's requirement for pediatric dental residency programs to train residents in advocacy. Because dentists are respected leaders in their community, the study results also support the integration of advocacy training into predoctoral dental curricula.

Science, Politics, and Communication: The Case of Community Water Fluoridation in the US

Community water fluoridation (CWF) and its effect in reducing the burden of dental caries (tooth decay) is considered one of the 10 public health achievements in the 20th century. In the U.S., three-quarters (74.4%) of people on community water supplies have optimally fluoridated water, and each year approximately 90 communities actively consider starting or discontinuing CWF. CWF exists within the policy environment and includes actions taken by local community councils, health and water boards, and groups; state legislatures and health departments; national regulatory and science agencies; independent science entities; and professional and nonprofit organizations. Epidemiologists have been in the forefront of CWF. Experience with the past 70 years reveals that the coming decades will bring additional questions, recommendations, and challenges for CWF. The continued involvement of epidemiologists as part of multidisciplinary teams is needed in research, surveillance, peer review of studies, assessment of systematic review findings, and in the translation and communication of science findings to audiences with limited science/health literacy. This chapter's purpose is to 1) examine how epidemiologic evidence regarding CWF has been translated into practice and policy, 2) examine how recommendations for and challenges to CWF have affected epidemiologic research and community decision-making, and 3) identify lessons learned for epidemiologists.

Perceived competency towards preventive dentistry among dental graduates: the need for curriculum change

BACKGROUND

A previous study has shown that dental practitioners in Benghazi believed that the less prevention-oriented education system is one of the barriers to applying preventive dentistry.

OBJECTIVE

To assess attitudes and perceived competence of the dental graduates in Benghazi towards prevention and early management of dental caries.

METHODS

A cross-sectional, questionnaire-based survey was conducted among internship students attending the Department of Community and Preventive Dentistry in Faculty of Dentistry, Benghazi, Libya. The participants were asked to provide demographic information, to respond to statements about their attitudes towards preventive dentistry, and to answer questions regarding their perceived competence in applying preventive dentistry procedures.

RESULTS

Data from 108 Libyan dental graduates were analysed for this study, of which 64% of them were females and 42.1% of them passed their final year with grade: acceptable. The most acknowledged aspects of preventive dentistry were being useful and essential to the community (95.4 and 90.8%, respectively). The percentage of participants expressing a proficiency in providing oral hygiene instructions was the highest (95.4%). There were differences between study subgroups in their perceived competence of preventive dental practices by gender and academic performance (p≤0.05).

CONCLUSION

This study highlighted that the currently implemented undergraduate education programme in Benghazi dental school does not provide dentists with the required attitude and skills to fulfil their role in providing preventive-oriented health services.

Perceived barriers to preventive dental care among Libyan dentists

AIM

To explore the barriers to providing preventive dental care to patients, as perceived by Libyan dentists working in Benghazi.

SETTINGS AND DESIGN

A cross-sectional, questionnaire-based survey was conducted among dentists working in Benghazi, Libya.

MATERIALS AND METHODS

All dentists registered with the Dental Association of Benghazi and with 2 or more years of practice were invited to participate. The questionnaire collected information on participants' demographic and professional characteristics as well as the patient-, practice- and dentist-related barriers to providing preventive dental care.

STATISTICAL ANALYSIS

Scores for each type of barrier were compared by demographic and professional characteristics in bivariate and multivariate analyses.

RESULTS

One hundred and seventy five dentists returned the questionnaires (response rate: 79%) and 166 had complete information on all the variables selected for analysis (75%). The majority were females (70%), aged between 23 and 34 years (85%), was working in the public health sector (43%), and had up to 5 years of service (46%). Patient-related barriers were scored the highest, followed by practice- and dentist-related barriers. Dentists with mixed practice reported lower scores on patient- and practice-related barriers than those in public or private practice.

CONCLUSION

Respondents were generally aware of the barriers to preventive dentistry and perceived the barriers as being more related to their patients than to their practices or themselves. However, these perceptions varied by practice sector.