Oral Problems and Self-Confidence in Preschool Children

Effectiveness of various methods of educating children and adolescents for the maintenance of oral health: A systematic review of randomized controlled trials

BACKGROUND

School-based oral health education has emerged as one of the most effective methods to instill a positive attitude toward oral health in children.

AIM

This systematic review (SR) aimed to assess the effectiveness of different methods of oral health education in children and adolescents.

DESIGN

Systematic search was conducted in PubMed, Cochrane, Web of Science, LILACS, Scopus, and EMBASE on January 29, 2023. Review included only randomized controlled trials (RCTs), and their risk of bias (ROB) was assessed by Cochrane RoB-2. Data were extracted and analyzed by expert group. The GRADE approach was used to assess the quality of evidence for each outcome. Every step was conducted in duplicate, and disagreements were resolved by consulting the third reviewer.

RESULTS

The SR included 10 RCTs with majority showing a high ROB. They included 12 methods with the commonest being the use of leaflets/flash cards. Most interventions were effective in improving oral hygiene, gingival health, and knowledge except conventional teaching methods, lecture by using PowerPoint by dentists, and e-learning interventions. The grade of evidence in the majority of outcomes was found to be low or very low.

CONCLUSION

Interventions using the interactive methods such as games, motivational-experiential learning, and audiovisual methods were found to be more effective than controls and other interventions. Variabilities in study methods and outcome variables must be addressed in the future.

Parental Knowledge, Attitude and Practices Toward Dental Sealants as Preventive Strategy for Dental Caries in Children: A Cross Sectional Study

Aim. This study aimed to evaluate the knowledge, attitude, and practices of parents residing in Pakistan toward pits and fissure sealants in children. Materials and Methods. This descriptive, cross-sectional study was carried out between November 2022 to March 2023. An online questionnaire was distributed through various social media platforms. Independent t-test and Multiple Linear Regression analysis were performed. Results. A total of 570 participants were recruited. For protection against tooth decay, most of the participants 456(80%) believed that fissure sealants should be placed to protect teeth from decay. Placement of fissure sealants was considered to be a cost-effective measure by majority of the 480 (84.2%) respondents. Conclusion. Fissure sealants are one of the most effective preventive measures against tooth decay. The knowledge, attitude and practice of parents were some being aware of fissure sealants and some were not. It appeared to support the placement of fissure sealants for their children.

Amelioration Strategies for Silver Diamine Fluoride: Moving from Black to White

Topical cariostatic agents have become a reasonable alternative for managing dental caries in young children. Silver diamine fluoride (SDF) is a practical topical approach to arrest caries and avoid extensive and risky dental treatment. However, the literature demonstrates a parental hesitation towards accepting SDF because of black unaesthetic tooth discolouration following application. The rapid oxidation of ionic silver darkens demineralised tooth structure permanently. In this regard, nano-metallic antimicrobials could augment or substitute for silver, and thereby enhance SDF aesthetic performance. Recently, biomedical research has drawn attention to selenium nanoparticles (SeNPs) due to their antimicrobial, antioxidant, and antiviral potencies. Various in vitro studies have examined the effect of SeNPs on the virulence of bacteria. This narrative review explores practical issues when using SDF and suggests future directions to develop it, focusing on antimicrobial metals. Several methods are described that could be followed to reduce the discolouration concern, including the use of nanoparticles of silver, of silver fluoride, or of selenium or other metals with antimicrobial actions. There could also be value in using remineralising agents other than fluoride, such as NPs of hydroxyapatite. There could be variations made to formulations in order to lower the levels of silver and fluoride in the SDF or even to replace one or both of the silver and fluoride components completely. Moreover, since oxidation processes appear central to the chemistry of the staining, adding SeNPs which have antioxidant actions could have an anti-staining benefit; SeNPs could be used for their antimicrobial actions as well. Future research should address the topic of selenium chemistry to optimise how SeNPs would be used with or in place of ionic silver. Incorporating other antimicrobial metals as nanoparticles should also be explored, taking into account the optimal physicochemical parameters for each of these.

Evaluation of the predictors of oral health-related quality of life among 3-5-year-old children with dental trauma

This study evaluated the influence of socio-demographic, clinical, and parental psychological factors on oral health-related quality of life (OHRQoL) and determined their predictors in preschool-aged children with traumatic dental injury (TDI). The study sample consisted of 324 dyads of children and their parents attending the Clinics of Pediatric Dentistry at Istanbul University. After clinical examination, the Sense of Coherence (SOC), Generalized Self-Efficacy Scale, Early Childhood Oral Health Impact Scale, and Multidimensional Health Locus of Control Scale-MHLC questionnaires were administered to the parents. The statistical analyses included Spearman correlation coefficients, Mann-Whitney U tests, Kruskal-Wallis tests, multiple linear regression, and confirmatory factor analysis. Having mixed TDI, a non-nuclear family, fewer children, and weak parental SOC were important predictors of worse overall OHRQoL and its sections of child and family. Lower internal health locus of control and dental pain due to TDI were predictors of worse overall OHRQoL and child impact, respectively. Consideration of these predictors may help oral health professionals to develop prevention and treatment programs for TDI and oral health literacy programs for families.

Planning, implementation, and evaluation of educational intervention based on PRECEDE-PROCEED model for mothers about oral health promotion on children aged 3-6 years

BACKGROUND

Mothers play an important role in oral health of children. The present study was planned, implemented, and evaluated to determine the impact of mothers' educational program based on PRECEDE-PROCEED model on oral health promotion of Rafsanjan 3-6-year-old children, in 2020.

MATERIALS AND METHODS

This quasi-experimental study was conducted on 100 mothers with children aged 3-6 years divided into two groups. The research tool was developed and approved based on the model phases in the form of demographic information, predisposing, enabling, and reinforcing factors. At phase five, intervention planning was conducted and the program was implemented in four sessions (45 min each) in 30 days. Follow-up was done 2 months after the last training session. The data were analyzed by SPSS18, using Chi-square, paired t-test, and independent t-test at the significance level of 0.05.

RESULTS

After implementing the program, a significant difference was observed between predisposing, enabling, and reinforcing factors, as well as oral health-related behaviors of the two groups (P < 0.05). Finally, 30.4% of the changes in oral health-related behavior resulted from the implementation of the designed educational program.

CONCLUSION

Considering the importance of planning to promote children's oral health and hygiene, it is recommended that the PRECEDE-PROCEED model be used to design, implement, and evaluate health evidence-based interventions.

Oral Health-Related Quality of Life in Children and Adolescents with a Traumatic Injury of Permanent Teeth and the Impact on Their Families: A Systematic Review

The aim of this systematic review was to evaluate the impact of a traumatic dental injury (TDI) of permanent teeth in children and adolescents on their oral health-related quality of life (OHRQoL) as well as on their families. A bibliographic search in the biomedical databases (PubMed, Cochrane Library, MEDLINE) was limited to studies published between January 2000 and February 2021. The study selection criteria were cross-sectional, case control, or prospective clinical studies, which analyzed TDI before and after the treatment of permanent teeth in healthy children and adolescent, assessed their OHRQoL, and were written in English. The search found 25 eligible articles that were included in the study. The quality assessment of the studies was performed using the quality assessment checklist for survey studies in psychology (Q-SSP). The results indicated that a TDI of permanent teeth strongly influences the OHRQoL of children and adolescents, and the timely-performed dental management of a TDI allows for preventing further biological and socio-psychological impacts. Sociodemographic status, economic status, parent’s education, gender, age group, and type of schooling were determinants of the TDI impact on OHRQoL.

Salutogenesis in oral health research in preschool children: A scoping review

BACKGROUND

Oral health research in children has focused both on identifying the risk factors for dental caries and on the impact the disease has on children's life.

AIM

Identifying studies that used the salutogenic theory to investigate positive aspects to promote a healthy condition in preschool children.

DESIGN

A literature scoping review was conducted to answer the question: 'What has been produced in scientific literature about children's oral health with a salutogenic theoretical reference?' The checklist preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) was applied. The research was conducted on the databases PubMed, Scopus, and Web of Science with no language, design, country or date restrictions. Three independent reviewers selected the studies to be included in the research, extracted data, and assessed the studies' contribution to the review.

RESULTS

Among the 38 studies retained, 10 were included, those were published between 2009 and 2018: five in Brazil, two in the United States of America, and one in Canada, China and India, respectively. All articles were published in English language. Nine studies investigated the relation between the parents'/caretakers' sense of coherence and aspects related to the children's oral health condition. One study investigated health factors among the parents of caries-free children.

CONCLUSION

Salutogenic orientation must be included in oral health research, so that salutary and risk factors may coexist, contributing to a new perspective for oral health promotion among children.

Dental injuries in paediatric mandibular fracture patients

Purpose

Dental injuries (DIs) are associated with facial fractures, particularly mandibular fractures. As paediatric mandibular fractures have special features, we sought to clarify the occurrence and types of DIs among this patient group. We assessed how age, injury type, and fracture location affects the occurrence of DIs and thereby defined which patients are most susceptible.

Methods

This retrospective study included patients < 18 years with a recent mandibular fracture. Predictor variables were gender, age group, mechanism of injury, type of mandibular fracture, and other associated facial fracture(s). Types and locations of DIs and tooth loss due to injury were also reported.

Results

DIs were detected in 34.7% (n = 41) out of 118 patients. Patients with tooth injury had on average 3.5 injured teeth. A total of 16.2% of injured teeth were lost, typically at the time of the injury. Loss of at least one tooth was seen in approximately 10% of patients. Avulsion was the most common cause of tooth loss (52.2%). Non-complicated crown fracture (50.7%) was the most common DI type. Statistically significant associations between studied variables and DIs were not detected.

Conclusion

DIs are common and often multiple in paediatric mandibular fracture patients regardless of background factors. DIs often lead to tooth loss. Prompt replantation of an avulsed tooth, early detection of DIs, and prevention of tooth loss whenever possible are important to avoid permanent tooth defects.

Correspondence for the article titled: "Impact of uncomplicated traumatic dental injuries on the quality of life of children and adolescents: a systematic review and meta-analysis"

As part of the critical appraisal exercise in our center, we reviewed the article published in BMC Oral Health, titled "Impact of uncomplicated traumatic dental injuries on the quality of life of children and adolescents: a systematic review and meta-analysis" authored by Lopez et al. (BMC Oral Health 19(1):224, 2019). We noted a plausible error that can influence the outcomes of this systematic review and meta-analysis which necessitates interpreting the findings of this systematic review with caution.

Impact of Oral Health on the Quality of Life of Preschoolers and Their Families

The aim of this study was to evaluate how the oral hygiene condition can influence the Oral Health-Related Quality of Life (OHRQoL) of preschoolers and their families. A cross-sectional study was conducted involving 446 children aged 2 to 6 years from public schools located in Rio de Janeiro, Brazil. The groups were dichotomized: regular/poor oral hygiene condition (RPOH) or good oral hygiene condition (GOH). The caregivers answered the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS). The average score in the RPOH group was 6.36 (6.35 DP) and GOH was 4.43 (5.35 SD) (P < .01). In the child subscale, the average of the RPOH and GOH group were, respectively, 4.12 (4.14 DP) and 3.13 (3.66 DP) (P = .01). In the family subscale, RPOH and GOH group were, respectively, 2.24 (3.12 DP) and 1.29 (2.52 DP) (P = .01). RPOH group had the greatest impact on OHRQoL.

Psychometric Analyses of the Indian (Hindi) Version of the Child Perception Questionnaire (CPQ11-14)

The current research aims to evaluate the reliability and validity of the Hindi Child Perception Questionnaire (CPQ_11-14) in a child population of India. A randomly selected sample of children aged 11-14 years (n = 331) and their parents completed the Hindi translation of CPQ_11-14 and the Parental-Caregiver Perceptions Questionnaire (P-CPQ), respectively, in this cross-sectional study. Children also provided a self-rating of oral health and were examined for dental caries. Exploratory Factor Analysis (EFA) was conducted to assess the dimensionality of the Hindi-CPQ_11-14. Internal consistency and reliability on repeated administration were evaluated. Convergent and divergent validities were determined by estimating correlation coefficients between items and the hypothesised subscales. Concurrent validity was assessed using multiple linear regression analyses. The four factors extracted in EFA had a total variance of 38.5%, comprising 31 items. Cronbach's alpha for the internal consistency of the overall scale was 0.90; reliability on repeated administration was 0.92. All the Hindi CPQ_11-14 items had an item-hypothesised subscale correlation coefficient of ≥0.4, and these were greater than item-other hypothesised subscale correlations, demonstrating good convergent and divergent validities respectively. Hindi-CPQ_11-14 was associated with self-ratings of the oral health and overall P-CPQ scores demonstrating good concurrent validity. Hindi-CPQ_11-14 showed a factor structure different from the English CPQ_11-14 and exhibited good validity and reliability.

Do malocclusion and orthodontic treatment impact oral health? A systematic review and meta-analysis

INTRODUCTION

Currently, there is limited evidence on the effects of malocclusion on oral health and whether the correction of malocclusion results in an improvement in oral health. In this review, we examined the evidence from randomized controlled trials and prospective cohort studies to provide information on any association between malocclusion and oral health and the effects of orthodontic treatment.

METHODS

We conducted this review in 2 parts: (1) we looked at the impact of malocclusion on oral health, and (2) we reviewed the evidence on the effect of orthodontic treatment on oral health. We searched for randomized controlled trials and prospective cohort studies. The searches were completed for articles published between January 1, 1990 and October 8, 2018 and covered Medline via Ovid, Embase, and the Cochrane Database of Systematic Reviews. References of included articles and previous systematic reviews were hand-searched. No language restrictions were applied. Two members of the study team assessed the quality of the studies using the Appraisal Tool for Cross-Sectional Studies to appraise the quality of studies in part 1. The assessment was performed at the study level. Two authors assessed each study independently, with a third author consulted when a disagreement occurred. For studies in part 2, we used the Newcastle-Ottawa scale to assess the risk of bias. When studies were included in a Cochrane review, we incorporated the risk of bias assessment. We developed data extraction forms for each area of oral health under investigation (trauma, quality of life, caries, and periodontal disease). Each author piloted the form, and we held discussions to inform any necessary refinements. We extracted data from studies into 2 × 2 tables, which provided a binary analysis of malocclusion vs the outcome of interest. If these data were not available from the published paper, then studies were not included in the meta-analysis. The authors were contacted when possible to request data in this format.

RESULTS

For part 1 of the study, we identified 87 studies. The overall quality was low. We could not include any of the data into an analysis because of a large variation in the nature of the studies, data collected, and outcome measures that were selected. For part 2 of the study, we found 7 studies; however, there were similar deficiencies in the data as in part 1, and thus, we could not reach any strong conclusions.

CONCLUSIONS

Overall, there is an absence of published evidence regarding the effects of malocclusion on oral health and the impact of orthodontic treatment on oral health.

Exploring the impact of oral health-related quality of life on the child’s family structure

Aim: The aim of this study was to explore the impact of oral health-related quality of life (OHRQoL) on the child’s family structure. Methods: A representative sample of 613 children from public preschools, in a city in southeastern Brazil, were enrolled in this cross-sectional study. The sample was determined through probabilistic sampling in two stages (preschools and children). The outcome variable (Early Childhood Oral Health Impact Scale [ECOHIS]) was multi-categorized in children and family. Independent individual variables were sex, race, family income, parents’/caregivers’ level of education, family income, dental caries, and malocclusion. Initially, individual analyses were performed, relating the study variables to the outcome variables, estimating the raw odds ratio with the respective confidence intervals of 95%. The variables with p < 0.20 in the individual analyses were tested in the multiple logistic regression models, and those with p < 0.10 remained in the model. Results: Impact on OHRQoL was reported by 40.9% of the children and 17% of their families. Children with low family income and caries experience had, respectively, 1.53 (95% CI: 1.00-2.32) (p = 0.0465) and 2.96 (95% CI: 1.81-4.84) (p < 0.0001) more chance of presenting negative impact on OHRQoL. Conclusions: The aspects that most affected the OHRQoL of child’s family structure were low income and dental caries experience.

Adolescents with worse levels of oral health literacy have more cavitated carious lesions

The aim of the present study was to investigate whether the ability to recognize and read oral health terms is associated with the number of teeth with cavitated carious lesions in adolescents. A population-based cross-sectional study was conducted involving a sample of 746 adolescents representative of students aged 15 to 19 years at the public and private school systems in a city in northeast Brazil. Two examiners who had undergone a training and calibration exercise (inter-examiner and intra-examiner Kappa coefficient: 0.87 to 0.93) performed the diagnosis of caries using the Nyvad Index and evaluated the level of OHL (BREALD-30) of the adolescents. The participants answered questions regarding their history of visits to the dentist and the parents/caregivers answered a questionnaire addressing socioeconomic characteristics. A directed acyclic graph was created to direct the selection of covariables for adjustments in the Poisson multiple regression analysis to test the association between dental caries and OHL (α = 5%). Cavitated carious lesions (codes 3 to 6 on the Nyvad index) were found in 41.6% of the adolescents. Only 29.4% had a high level of OHL (BREALD-30 scores between 23 and 30); 42.3% of the families belonged to the A-B social class and 93% of the adolescents had been to the dentist at least once in their lifetimes. In the multivariate analysis, adolescents with inadequate (PR: 1.69; 95% CI: 1.18–2.41; p = 0.004) and marginal (PR; 1.42; 95% CI: 1.01–1.99; p = 0.042) OHL and those in the lower social classes (C-D-E) (PR: 1.85; 95% CI: 1.39–2.47; p<0.001) had more teeth with cavitated carious lesions. In conclusion, adolescents aged 15 to 19 years with poorer levels of OHL had a larger number of teeth with cavitated carious lesions, independently of their socioeconomic status and history of visiting a dentist.

[Dental pain among psychoactive substance users in CAPS AD in Vitoria, Vila Velha and Serra, ES, Brazil]

Toothache is a public health problem that causes great inconvenience to psychoactive substances users. The objective was to verify the prevalence of dental pain and its associations among psychoactive substances users from Alcohol and Drug Psychosocial Care Centers (CAPS AD) in Vitoria, Vila Velha and Serra, Espírito Santo, Brazil. A transversal study was conducted with 280 participants between June 2015 and February 2016, using five scripts: one for socio-demographic data and health perception; another for oral health; the Oral Health Impact Profile; the Alcohol Smoking and Substance Involvement Screening Test and the World Health Organization Quality of Life Test. Data were organized in frequency tables and analyzed with the SPSS 20 statistical package. Comparisons were made with Fisher's test and the Odds Ratio (OR) was used to check the strength of the association between the variables. The prevalence of pain in the population studied was 59.3%, and individuals whose quality of life was impacted due to their oral conditions were 2.2 times more likely to report toothache in the last 6 months. The population studied showed a high prevalence of dental pain and the study indicates that dental pain interferes in the quality of life of psychoactive substances users who are treated at CAPS AD services in these three cities.

Impact of uncomplicated traumatic dental injuries on the quality of life of children and adolescents: a systematic review and meta-analysis

BACKGROUND

Traumatic dental injuries (TDIs) are highly prevalent during childhood and adolescence and have a significant effect on their oral health related quality of life (OHRQoL). Uncomplicated TDIs, dental trauma involving enamel, enamel and dentin and tooth discolorations, account for approximately two-thirds of all diagnosed TDIs in children and adolescents. Hence, it may be important to understand the impact of uncomplicated TDIs on OHRQoL, by synthesizing the available literature.

METHODS

Medline, Embase, Web of Science and Scopus databases were systematically searched from January 1966 to April 2018. Studies that evaluated the effect of TDIs on the OHRQoL of children and adolescents using validated methods were selected for analysis. A narrative synthesis and a meta-analysis were performed. The studies were pooled according to age groups and OHRQoL questionnaire used. A random-effect model was applied to calculate the pooled odds ratios (OR) and their respective 95% confidence intervals.

RESULTS

There were 712 identified studies. Of these, 26 articles were selected for the review and included in the narrative synthesis, 20 of these articles concluded that uncomplicated TDIs were not associated with a negative impact in OHRQoL. Seventeen were included in the meta-analysis. The estimates were pooled by age groups: children (OR: 1.01; 95%CI; 0.85-1.19; I² = 51.9%) and adolescents (OR: 1.07; 95%CI; 0.91, 1.26; I² = 50.2%).When pooling all estimates the OR was 0.96 (95% CI: 0.85-1.10; I² = 61.4%).

CONCLUSIONS

Uncomplicated TDIs do not have a negative impact on the OHRQoL of children and adolescents. Further prospective studies are needed to confirm the results of this review. The majority of the studies included were of cross-sectional design, which may have limited the ability to reach conclusions on the nature of this association. The PROSPERO systematic review registry is CRD42018110471.