Program for Dental Health Advancement in Children "Dental Passport"

Oral health system strengthening in fragile and conflict-affected states: A systematic review

Background

Oral diseases affect nearly half of the global population, presenting significant challenges in fragile and conflict-affected states. Despite comprising a population of over one billion people, oral health data and comprehensive evidence on oral health system strengthening on these countries are limited. This study, therefore, aims to explore oral health system strengthening in fragile and conflict-affected states by synthesising evidence from relevant global literature.

Methods

We conducted a systematic review of literature across Ovid MEDLINE, EMBASE, Global Health, Scopus, Web of Science, and grey literature databases. The methodological quality of published literature was assessed using the relevant Joanna Briggs Institute critical appraisal tools. The findings were narratively synthesised and presented using the Lancet's high-quality health system framework.

Results

The review included 23 papers from 12 countries. The evidence documented impacts of armed conflicts, political crisis, pandemics, and natural disasters on oral health systems, and initiatives to strengthen them focusing on the 'foundations' domain. The initiatives included: workforce development and career opportunities; health service platforms such as mobile dental services and teledentistry; integration of oral health into national health systems and emergency responses; contingency planning and adaptability; and effective governance such as financing systems and infrastructures. Collaborative action, both local and international, including monitoring and evaluation were emphasised as key strategies for health system strengthening to ensure an equitable distribution of responsibilities and resources.

Conclusions

Whilst evidence on oral health system strengthening in fragile and conflict-affected states is limited, our findings suggest the need for integrated action, such as mobilising local resources and engaging stakeholders equitably. Further research, with particular focus in the area of processes of care and quality impacts, is necessary to explore comprehensive strategies for strengthening the oral health system.

Early Childhood Oral Health Impact Scale: Psychometric Evaluation in Portuguese Preschoolers

Objective

to contribute to the validation of the Early Childhood Oral Impact Scale (ECOHIS) by studying its psychometric properties when applied to a Portuguese preschool population.

Methods

Cross-sectional study conducted with children aged between three and five-years-old. The non-probabilistic sample included two preschools in the municipality of Lisbon. Children who agreed to participate and whose guardians signed the informed consent were included. Data collection included a questionnaire, administered to the parents, and an intraoral examination of the children. The questionnaire included the Portuguese version of ECOHIS. The intraoral examination included the caries diagnosis according to the World Health Organization criteria. Discriminant validity compared the ECOHIS score between children with and without caries experience (Mann-Whitney U-test). Cohen's d was calculated to estimate the magnitude of the difference. Reliability analysis included Cronbach's α and test-retest. Construct validity was analyzed by the correlation between the ECOHIS score and dmft (Spearman's correlation). A significance level of 5% was used.

Results

The sample included 104 children (mean age 4.1 years). ECOHIS values were significantly different between children with and without caries (p=0.004). The Cohen's d was 0.84. The Cronbach's was 0.78, with no significant increase in value when eliminating any of the items. The test-retest showed significant correlation (r=0.76; p=0.01). There was a significant correlation between the ECOHIS score and caries experience (r=0.28; p=0.004).

Conclusion

The Portuguese version of the ECOHIS showed good psychometric properties, indicating that it is a reliable and valid tool to measure the impact of oral health in preschool children.

Treatment priorities and arrival time of traumatic dental injuries-An 8-year retrospective study

BACKGROUND/AIM

Most of the previous studies in the available literature discussed the time of arrival in general to the healthcare system, while a minority studied the relationship between the type of trauma and arrival. The aim of this retrospective study is to assess the arrival time of traumatic dental injuries (TDIs) depending on the urgency of treatment according to Andreasen.

MATERIALS AND METHODS

This 8-year retrospective study was carried out at the Department of Pediatric Dentistry at the University Dental Clinic in Zagreb, Croatia. Andreasen's classification was used to define the kind of TDI as well as to divide them by the need for urgent treatment or treatment priorities in three groups: acute, subacute, and delayed.

RESULTS

The sample consisted of 1040 children (59% male and 41% female) with a median age of 7. Each year, the age group most affected by TDIs was 6-12 years old. While there is a general increase in the prevalence of TDIs overall, there is a decline in TDIs among children aged 6-12 and an increase among preschoolers and adolescents (below 6 and above 12 years old). Throughout the years, 52.73% red/acute and 41.16% yellow/subacute TDIs were not treated on time due to delayed arrival. More patients from Zagreb come in the first 24 h, while more patients from outside Zagreb come to the clinic a month or more after their injuries. Patients which suffered TDI accompanied with soft-tissue injury arrived sooner.

CONCLUSIONS

It is necessary to introduce monitoring and education of patients under the age of 6 and over 12, as well as their parents/caregivers. New programs should be implemented and new referent centers that specialize in treating TDIs outside of Zagreb should be established.

Dental Caries Experience in Children in Public Kindergartens of Sarajevo, Bosnia and Herzegovina

OBJECTIVES

Dental caries first occurs within primary dentition in toddlers and preschool children, in a form of early childhood caries (ECC). In every day's busy and employment burdened parenting, caretakers and institutions have become important even more nowadays, not only for forming child general behavior and character, but also for maintenance of their general and oral health as well.

AIMS

To evaluate the presence and severity of ECC in children who attended public kindergartens in Sarajevo, and to offer basic information for the maintenance and improvement of child oral health to their parents and kindergarten teachers.

METHODS

The study included 1722 preschool children aged 3-6 years who attended kindergartens within Sarajevo public kindergarten institution, together with their parents and kindergarten teachers. Dental team members gradually visited all kindergartens situated in four Sarajevo city municipalities and examined kindergarten children according to the WHO Oral Health Survey Manual. Oral health promotion material for parents and kindergarten teachers was also distributed simultaneously during sequential visits.

RESULTS

ECC was present in preschool kindergarten children in Sarajevo, with its high prevalence (67.71%); dmft-value (3.97) and severity (SiC index 8.79). There was also a significant lack of dental healthcare to examined children mostly related to lack of visiting dental offices by children's parents (CI=10.55%, RI=10.80%, TI=12.98%).

CONCLUSION

Parental role in preserving and improving of their children oral health should be systematically and profoundly improved. Kindergarten officials and staff should recognize the importance of anticariogenic diet menus and oral hygiene maintenance within their institutions.

Improving oral health of children in four Balkan countries: A qualitative study among health professionals

Data from the WHO show that the oral health situation for children in the Balkan region of Europe is poor. This study aims to identify obstacles that prevent the implementation of an effective oral health program for children in the Balkan area. The study investigates the challenges that people encounter in increasing awareness, attending to dental care, and complying with examinations.

Methods

This qualitative study targeted experts in preventive dentistry and oral health promotion in four countries in the Balkan region. Purposive sampling was used to recruit the participants. Data were collected in 2021 using individual in-depth interviews with participants from Albania, Bosnia and Herzegovina, Croatia, and Serbia. The study applied the thematic analysis method.

Results

The experts reported four main challenges that hindered the implementation of a prevention program and regular patient attendance: (1) lack of knowledge, (2) the exclusion of oral health from overall health, (3) organization of services, and (4) skepticism of fluoride. The participants identified knowledge gaps among the general population, dental staff, and other health professionals regarding the prevention of oral diseases.

Conclusion

The findings of this study may be used to promote and improve oral health among children in the identified areas and to benefit people in the region and elsewhere. This study sheds light on the existing barriers in a region where people lack information.

Satisfaction of Parents and Caregivers with Dental Treatment of Children Under General Anesthesia in a Day Care Surgery Setting

Objective

The aim of this study was to examine the satisfaction of parents and caregivers of patients who underwent dental treatment in general anesthesia (GA) in a day-care surgery setting.

Material and Methods

Anonymous questionnaire was sent to parents/caregivers of patients who underwent full mouth restoration in GA. The survey consisted of 4 parts: general data, data about procedure, satisfaction with various aspects of care and the perception of parents/caregivers about the condition of their child in relation to the time before dental treatment in GA.

Results

66 parents/caregivers (30.5%) responded to the questionnaire. Overall satisfaction with the treatment was high (4.69). Respondents expressed the highest degree of satisfaction with communication with nurses (4.92), and the lowest with the waiting time for the procedure (3.89). Parents/caregivers of patients who reported difficulty eating expressed significantly lower overall satisfaction than the subjects whose children did not report difficulty eating. Also, the more treatments the patients underwent, the lower was the overall satisfaction than of those subjects whose children were never treated in such a manner before.

Conclusions

Since patient satisfaction has a beneficial impact on treatment outcome and adherence to preventive recommendations, all health care providers should strive to achieve it.

Relationship between Children's and Parents' Dental Anxiety: A Cross-Sectional Study on the Six European Countries

Background: The purpose of this study is to investigate the relationship between children’s and parents’ dental anxiety. Methods: 731 children of different ages and their parents from six European countries participated in this study. Dental anxiety was investigated through an online questionnaire, which consisted of general questions and the Corah Dental Anxiety Scale (CDAS), which is a questionnaire that measures respondents’ reactions on a 5-point scale for four different situations. Results: CDAS results were calculated for all children and their parents. A total of 12.5% of children from Croatia, 26.67% from Macedonia, 10.94% from Bosnia and Herzegovina, 20.31% from Montenegro, 23.08% from Slovenia and 16.10% from Serbia showed a high level of anxiety. The correlation between dental anxiety of parents and children was 0.4 (p < 0.01). Conclusions: Parents with negative experience from a dental office can have a bad effect on their child’s behaviour, which results in the creation of a non-active patient. Due to the clear and existing cause-and-effect relationship of dental anxiety in children and parents, it is extremely important to educate parents about the proper psychological approach to children in order to promote positive experiences from dental offices, as well as to emphasize the importance of regular visits to the dentist.

Comparison of Different Methods of Education in the Adoption of Oral Health Care Knowledge

AIM

The scope of this study was to determine if there is a critical distinction in the usage of lectures, videos, and pamphlets as educational material utilized in the adoption of oral health care knowledge.

MATERIALS AND METHODS

Three-hundred and thirty children from ages 11 to 13 from the city of Split, Croatia completed the questionnaire on oral health care knowledge. Consequently, they were educated by randomly using a method: lecture, pamphlet, or video. Finally, after education, their knowledge was tested again.

RESULTS

Different statistical tests were used for comparison of different sets of data. The Wilcoxon signed-rank test showed a statistically significant difference (p ˂ 0.001) compared to the results before and after education. The Kruskal-Wallis test comparing knowledge outcomes after three different types of education: video, lecture, and pamphlet, showed a statistically significant difference in the final knowledge between groups (p ˂ 0.05). A pairwise comparison between different types of education showed a significant statistical difference between education conducted by pamphlet and video material (p = 0.003) and pamphlet and lecture (p = 0.006). No difference was observed between the level of knowledge acquired through video material education and lectures (p = 0.928).

CONCLUSION

Videos and lectures as means of education showed equal effectiveness in the adoption of oral health care knowledge, while the pamphlet was a method that proved to be less effective.