Maintaining Traditions: A Qualitative Study of Early Childhood Caries Risk and Protective Factors in an Indigenous Community

A Qualitative Follow-Up to a Survey of Program Directors on Wellness Programming at a Large Healthcare Organization: Interviews of High- and Low-Exemplar Programs

Background

The current research used a qualitative approach to understand which factors facilitate and hinder wellness programming in residency programs.

Methods

Program directors identified from a previous quantitative study as having residency programs with notably more or less resident wellness programming than others (ie, high- and low-exemplars, respectively) were contacted. In total, semi-structured interviews were conducted over Zoom with 7 low-exemplars and 9 high-exemplars.

Results

The results of this qualitative examination suggest common themes across the 2 exemplar groups, such as wanting more resources for resident wellness with fewer barriers to implementation, viewing wellness as purpose-driven, and seeing wellness as a shared responsibility. There were also critical distinctions between the exemplar groups. Those high in wellness programming expressed more of an emphasis on connections among residents in the program and between the faculty and residents. In contrast, those low in wellness programming described more barriers, such as staffing problems (ie, turnover and lack of faculty wellness) and a lack of integration between the varying levels involved in graduate medical education (GME) operations (ie, between GME programs and sponsoring hospitals, and between GME facilities and the larger health care organization).

Conclusion

This study provides insight into program directors' experiences with wellness programming at a large health care organization. The results could point to potential next steps for investigating how the medical education community can improve resident wellness programming.

Discrimination and Dignity Experiences in Prior Oral Care Visits Predict Racialized Oral Health Inequities Among Nationally Representative US Adults

Racism, an oppressive and fallacious sociopolitical hierarchy, is a fundamental cause of oral health inequities worldwide. Everyday discrimination is associated with worse self-rated oral health, toothache and adult tooth loss, and lower oral care utilization. Few studies examine discrimination or microaggressions within oral care settings or their effects on oral health outcomes. We adapted the seven-item Everyday Discrimination Scale to the oral care setting (EDSOC); developed a four-item Dignity in Oral Care Scale (DOCS); fielded them to a probability-based nationally representative sample of US households as part of the 2022 State of Oral Health Equity in America survey (SOHEA, n = 5682); and examined associations between EDSOC and DOCS scores and three outcomes: self-rated oral health, duration since last oral care visit, and planning for future preventive/routine oral care. Nearly, all EDSCOC and DOCS measures were significantly associated with oral health outcomes. Discrimination experience in dental settings had an additive effect on reporting fair/poor oral health and a suppressive effect on planning a future dental visit. Indignity experience doubled-to-quadrupled the likelihood of reporting fair/poor oral health, not having visited a dentist in 2 years, and not planning a future oral care visit. Racio-ethnically minoritized patients may experience the unjust double bind of resolving urgent dental or completing preventive services needs amidst being treated in a discriminatory manner or without dignity. Oral health stakeholders should invest more effort to understand relationships between racism and oral health outcomes and introduce evidence-based interventions to ultimately abolish this societal harm.

Social and Preventive Factors That Explain Oral Health among Pregnant Women in the Canton of Cuenca, Ecuador

(1) Background: pregnant women in underprivileged areas may face challenges that affect their oral health. The analysis of these issues such as toothaches or cavities, among others could be crucial for them. However, no studies have been conducted in Cuenca, Ecuador. Thus, this study aimed to create a model explaining how social factors and healthy habits impact oral health in Cuenca, Ecuador. (2) Methods: An observational study was performed using a questionnaire developed from scratch. Principal component factor analysis was performed to calculate the oral disease index based on the oral health issues reported by women during pregnancy. (3) Results: 1971 women participated in the research. In total, 88% reported at least one oral health problem, with cavities (34%) and bleeding gums (33%) as the most prevalent. The rate of preventive visits and frequent brushing were the two variables that most impacted the oral disease index. The consumption of sweets, age, and the belief that visiting the dentist harms their unborn child were also important factors. However, income, education, and ethnic background showed little to no effect. (4) Conclusions: The most beneficial determinants of oral health factors in pregnant women in Cuenca, Ecuador, are preventive dentist visits, frequent brushing, and a contained consumption of sweets. The main harmful factors are age and the misconception that dental visits can harm their unborn child. Surprisingly, income, education, and ethnic background have little effect. This study can be replicated in other countries and cultures.

Early Feeding and Weaning Practices of Indian Children with Early Childhood Caries: A Qualitative Exploration

OBJECTIVE

To describe the early feeding, weaning, and oral hygiene practices of children with early childhood caries (ECC), their parents' knowledge and attitudes regarding infant feeding, and the feeding-related challenges faced by the parents.

METHODS

This descriptive qualitative study involved parents of children with ECC who sought dental treatment at an academic dental college in India. Data were collected though focus groups conducted with the 27 parents of children with ECC, using a focus group discussion guide. Data were analyzed using the content analysis method.

RESULTS

Community norms, such as learning from the older women in the families or neighborhoods, guided the feeding method, duration of feeding, and weaning. Breastfeeding or bottle-feeding at bedtime beyond 12 mo of age and feeding sugary drinks during weaning were standard practices, despite knowing the risk for dental caries. Parents faced multiple challenges regarding weaning and were unaware of the significance of infant oral hygiene practices.

CONCLUSION

In children with ECC, infant feeding practices included prolonged breastfeeding or bottle-feeding beyond the required age, feeding at bedtime, and feeding sugary drinks. Although the parents knew that these feeding habits could increase the risk for caries, they lacked the self-efficacy to translate their knowledge into action during weaning. Also, they lacked awareness regarding infant oral hygiene practices.

KNOWLEDGE TRANSFER STATEMENT

The study provides information on the feeding habits of infants that can increase the risk for caries, the challenges faced by the parents of these children in altering these risky habits, and their lack of knowledge on infant oral hygiene practices. Policy/decision makers can advocate for pediatricians and pediatric dentists to incorporate anticipatory guidance or motivational interviewing techniques to tailor the preventive program for ECC for Indian children.

Oral Health Status of Ngäbe-Buglé Children in Panama: A Cross Sectional Study

BACKGROUND

Poor oral health is often more prevalent in rural and resource-limited areas. Evaluating oral health status in these communities is the first step in ensuring adequate future health care for the population. The aim of this study was to assess the oral health status of children aged 6-12 years living in the indigenous Ngäbe-Buglé communities.

METHODS

A cross-sectional study was conducted in two rural indigenous communities of Ngäbe-Buglé on San Cristobal Island in Bocas del Toro, Panama. All children between 6 and 12 years of age and attending local schools were invited to participate, and those whose parents provided oral consent were enrolled. Dental examinations were performed by one trained dentist. To describe oral health, plaque index, DMFT/dmft (decayed, missing, and filled for permanent and primary teeth) index, and developmental defects of enamel index were recorded. Orthodontic characteristics were also evaluated, assessing the prevalence of different molar classes and the prevalence of open bite, lateral crossbite, and scissor bite.

RESULTS

A total of 106 children, representing 37.3% of the child population in the age range attending local schools, were included in this study. The mean plaque index of the entire population was 2.8 (SD 0.8). Caries lesions were more common in children living in San Cristobal (80.0%) compared to those living in Valle Escondido (78.3%), p = 0.827. The mean DMFT/dmft for the entire population was 3.3 (SD 2.9). Developmental defects of enamel were recorded in 49 children (46.2%). The majority of the population had a class I molar relationship (80.0%). Anterior open bite, lateral crossbite, and anterior crossbite were found in 10.4%, 4.7%, and 2.8% of the participants, respectively.

CONCLUSIONS

The oral health of children living in Ngäbe-Buglé communities is generally poor. Oral health education programs for children and adults might play a crucial role in improving the oral health status of the Ngäbe-Buglé population. In addition, the implementation of preventative measures, such as water fluoridation as well as regular toothbrushing with fluoridated toothpaste and more accessible dental care, will be essential in improving future generations' oral health.

Seeking Sweetness: A Systematic Scoping Review of Factors Influencing Sugar-Sweetened Beverage Consumption in Remote Indigenous Communities Worldwide

It is well-established that remote Indigenous communities have higher rates of sugar-sweetened beverage (SSB) consumption than non-Indigenous counterparts, which results in higher rates of chronic diseases such as type 2 diabetes mellitus (T2DM), obesity, and kidney disease. The aetiology leading to this behaviour remains understudied and overlooked. Therefore, the aim of this literature review is to understand the underpinning factors that contribute to SSB consumption in remote Indigenous communities. Studies were identified through five databases (n = 2529) and grey literature searching (n = 54). Following the PRISMA guidelines, each paper was assessed for eligibility, which left 34 studies for inclusion in the review. Within these papers, 37 different factors were found to influence SSB consumption in remote Indigenous communities. These were organised according to the Determinants of Nutrition and Eating (DONE) framework. SSB consumption was found to influence intake through each main level of the framework; individual (n = 9), interpersonal (n = 18), environmental (n = 9), and policy (n = 3). Preference was identified to be the most common factor to influence intake (n = 19), followed by health literacy (n = 15) and community availability (n = 12). Despite this, interventions to reduce SSB intake have never targeted this factor. This paper highlights the importance of a multi-level whole-of-system approach and suggests that an individual’s taste/preference should shape the direction of future research and intervention in this area.

Detection of Streptococcus mutans and Streptococcus sobrinus and Their Association with Oral Microbiome Stressors in 6-18-month-old Infants

Aim

To determine the presence of Streptococcus mutans (S. mutans) and Streptococcus sobrinus (S. sobrinus) and their association with extrinsic and intrinsic variables in 6-18-month-old infants.

Methods

This was an analytical, cross-sectional study of 65 6-18-month-old infants who visited the Centers for Early Childhood in Buenos Aires City. Three groups were established according to the presence of teeth-group I (GI)-edentulous infants, group II (GII)-infants with 1-8 teeth, and group III (GIII)-infants with 9-16 teeth. Data on the variables, diet, use of artificial teats, and oral hygiene were gathered using a self-administered questionnaire. An oral examination was performed according to the International Caries Detection and Assessment System (ICDAS II) criterion. A saliva sample was taken by aspiration with a sterile plastic syringe. Cariogenic Streptococci (CS) were counted using the adherence test in modified gold broth (AT-MGB). Molecular detection and quantification were performed by quantitative polymerase chain reaction (qPCR) (gtfB, gtfT, and tuf).

Results

A total of 12% of infants received oral hygiene, 38% used bottles, 30% used pacifiers, and 55% had sugar intake. S. sobrinus and S. mutans were detected in 57.1 and 28.6% of the children with caries, respectively. Groups I, II, and III had CS counts of log 2, 3.4, and 3.7, respectively. S. sobrinus was detected in 26.7% of GI, 52.9% of GII, and 85.7% of GIII, while S. mutans was detected in 13.3%, 35.3%, and 57.7%, respectively.

Conclusion

The prevalence of S. sobrinus was higher than S. mutans in all groups. The presence of CS was significantly associated with sugar intake. No association was found between S. mutans and S. sobrinus and the presence of caries, hygiene habits, or use of artificial teats.

Clinical Significance

This study supports the role of diet in developing a cariogenic biofilm in children under 2 years of age.

How to cite this article

Cornejo CF, Soken LJ, Salgado PA, et al. Detection of Streptococcus mutans and Streptococcus sobrinus and Their Association with Oral Microbiome Stressors in 6-18-month-old Infants. Int J Clin Pediatr Dent 2023;16(1):68-73.

Caries Experience and Treatment Needs in Urban and Rural Environments in School-Age Children from Three Provinces of Ecuador: A Cross-Sectional Study

In Ecuador, national epidemiological surveys have not been updated; however, some regional studies in the northern areas of the country still report a high prevalence of dental caries. The aim of this study was to determine the experience, severity, and need for treatment of dental caries in school children aged 6 to 12 years in urban and rural settings in three provinces of southern Ecuador. This cross-sectional, relational study examined 1938 schoolchildren in the provinces of Azuay, Cañar, and Morona Santiago. The survey instruments were based mainly on the WHO manual Methods of Oral Health Surveys (dmft) for primary and permanent dentition (DMFT), as well as the prevalence, severity, and Significant Caries Index (SCI). The parametric Student’s t-test was used to compare two groups, and the Spearman’s Rho and Tau-c Kendall correlation coefficients were used to associate the categorical variables. Results: The prevalence of caries in the primary dentition was 78% and 89.2% in the permanent dentition. The dmft (M = 4.12, SD = 2.86) and DMFT (M = 3.62: SD = 3.07) placed the general group in a moderate caries index. The need for treatment was 90.68% in the primary dentition, while it was 87.99% in the permanent dentition. Caries severity in both dentitions was high (M = 7.74; SD = 3.42). Conclusions. Alarming indicators of caries experience and the need for treatment were observed in the population studied.

Prevalence of Caries According to the ICDAS II in Children from 6 and 12 Years of Age from Southern Ecuadorian Regions

In Ecuador, national data on dental caries are scarce and the detection of incipient enamel lesions has been omitted. The objective of this study was to determine the prevalence of caries in school children aged 6 and 12 years of both sexes, belonging to urban and rural areas of three provinces of the country, using the International Caries Detection and Assessment System (ICDAS II). The sample consisted of 665 children from public schools, examined according to ICDASII. Caries prevalence and caries index were established using ICDAS II 2-6/C-G and ICDAS II 4-6/E-G criteria for comparison with WHO indicators. The Mann−Whitney U statistical test was used for comparison of two groups, the effect size was measured with the correlation coefficient. and the Kruskal−Wallis H test (p < 0.05) for multiple comparisons. Caries prevalence exceeded 87% for primary and permanent dentition. There were no significant differences according to province (p ≤ 0.05). The caries index at 6 years was 6.57 and at 12 years 9.21. The SIC was high at 12 years in rural areas. The prevalence of caries in the population studied was high despite the preventive measures established by health agencies.

Positive deviance in health and medical research on individual level outcomes - a review of methodology

BACKGROUND

Positive deviance as a methodology is increasing in application yet there is high variability in how this approach is applied in health services research.

METHODS

We conducted a scoping review of the literature for positive deviance applied to health outcomes informed by PRISMA-ScR. We searched the literature from 1945 to 2020, including articles on positive deviance or positive outliers, and restricted to examining individual rather than organizational outcomes. We analyzed the methodology applied including the process of identifying deviants, the use of control groups, and the degree of community engagement.

RESULTS

Our initial search identified 1140 manuscripts; we included 104 papers describing 98 studies, 11 topical and one miscellaneous category. Most studies used objective measures of health or survey-based responses to identify deviants from a sub-set of the population at risk. The use of controls was less common in some topics (hospital infections), whereas controls were universally applied in other topics (malnutrition). The degree of community engagement varied widely.

CONCLUSIONS

Positive deviance would benefit from improvements in reporting and standardized approaches to defining deviance. Studies could be improved through clarified definitions of deviance/risk, explicit descriptions of community engagement, and more consistent use of controls.

Pediatric oral health: community-based participatory research

Background

The most common chronic disease affecting children in Canada is dental caries. The objective of this study was to explore, identify, and address the strengths and barriers related to oral health services with an independent Indigenous community in Saskatchewan.

Methods

Community-based participatory research used interviews with Elders, health care providers, teachers, and parents/guardians of elementary school-aged children. The research focused on the development of genuine partnerships with the community. During data collection, the findings/results were returned to the community to establish direction, build success, and establish next steps. Thematic analysis was undertaken with the community. Descriptive statistics were analyzed using SPSS.

Results

The most commonly identified themes included: community resilience; the need for resource development and process to improve oral health literacy and skills; and how access to care barriers dually affected and related to personal and community cost, time, and human resources.

Conclusions

The research process involved the co-creation of tools to identify strengths within the community and drive opportunities for change; subsequently generating solutions to the practical problems and potentially transform the health system accessed by the community.

Child-, Family-, and Community-Level Facilitators for Promoting Oral Health Practices among Indigenous Children

Despite the preventive nature of oral diseases and their significance for general wellbeing, poor oral health is highly prevalent and has unfavourable ramifications for children around the world. Indigenous children in Australia experience disproportionate rates of early childhood caries compared to their non-Indigenous counterparts. Therefore, this paper aims to collate parental experiences and generate an understanding of facilitators for Indigenous childhood oral health. This project aggregated stories from parents of Indigenous children across South Australia who were participants in an early childhood caries-prevention trial. This paper explores facilitators for establishing oral health and nutrition behaviours for Indigenous children under the age of three through reflexive thematic analysis. Fisher-Owens’ conceptual model for influences on children’s oral health is utilised as a framework for thematic findings. Child-level facilitators include oral hygiene routines and regular water consumption. Family-level facilitators include familial ties, importance of knowledge, and positive oral health beliefs. Community-level facilitators include generational teaching, helpful community resources, and holistic health care. Recommendations from findings include the following: exploration of Indigenous health workers and elder participation in oral health initiatives; inclusion of Indigenous community representatives in mainstream oral health discussions; and incorporation of child-level, family-level, and community-level facilitators to increase support for efficacious oral health programs.

Early Childhood Caries in Indigenous Communities

The oral health of Indigenous children of Canada (First Nations, Inuit, and Métis) and the United States (American Indian and Alaska native) is a major child health disparity when compared with the general population of both countries. Early childhood caries (ECC) occurs in Indigenous children at an earlier age, with a higher prevalence, and at much greater severity than in the general population. ECC results in adverse oral health, affecting childhood health and well-being, and may result in high rates of costly surgical treatment under general anesthesia. ECC is an infectious disease that is influenced by multiple factors, but the social determinants of health are particularly important. This policy statement includes recommendations for preventive and clinical oral health care for infants, toddlers, preschool-aged children, and pregnant women by primary health care providers. It also addresses community-based health-promotion initiatives and access to dental care for Indigenous children. This policy statement encourages oral health interventions at early ages in Indigenous children, including referral to dental care for the use of sealants, interim therapeutic restorations, and silver diamine fluoride. Further community-based research on the microbiology, epidemiology, prevention, and management of ECC in Indigenous communities is also needed to reduce the dismally high rate of caries in this population.

Protective Factors for Early Childhood Caries in 3-Year-Old Children in Poland

Background: Early childhood caries (ECC) remains highly prevalent in preschool children worldwide. Dental caries affects every second 3-year-olds in Poland. The aim of the study was to assess protective factors for ECC in 3-year-olds. Methods: A cross-sectional survey was conducted in 2017 among 3-year-olds attending kindergartens in all 16 provinces of Poland. The questionnaire included socioeconomic factors, and oral health behaviors. Decayed, missing due to caries and filled teeth and surfaces were assessed. Caries indices (dmft and dmfs), percentage of caries-free and severe ECC (S-ECC) were calculated. The Student's t-test, Spearman correlation, univariate and multivariate logistic regression (the odds ratios (OR) and adjusted odds ratios (AOR): confounding factors: socioeconomic conditions, oral health behaviors) were performed; p < 0.05. Results: A total of 1,638 children were included. ECC was confirmed in 41.1%; S-ECC in 23.4%. The dmft index was 1.85 ± 3.14, dmfs = 2.99 ± 6.56. Spearman correlation [socioeconomic factors, especially mother's education (r = -0.148, p < 0.001) and family's economic status (r = -0.071, p = 0.004)], despite were statistically significant, indicate very weak relationships with dmft index. After 12th month of life not giving any beverages before bedtime and at night, but water or unsweetened milk only, healthy snacking (sandwiches, fresh fruit), or water on a daily basis decreases the probability of caries development (for S-ECC: OR = 0.37, AOR = 0.47, AOR2 = 0.37; p < 0.01), even if inappropriate dietary behaviors or hygiene practices were simultaneously present. Brushing of a child's teeth twice a day lowered the odds of caries (for S-ECC: OR = 0.78, p = 0.031; AOR = 0.81, p = 0.081; AOR2 = 0.84, p = 0.131), but this effect was less intense when inappropriate dietary behaviors were accounted for. Children of parents with good self-assessment of their teeth were more often caries-free (61.4 vs. 42.9%; p = 0.006) and had lower dmft indices (1.67 vs. 2.93; p = 0.002). Conclusions: Preventing a child after 12th month of life from getting any beverages before bedtime, water or unsweetened milk only, sandwiches and fresh fruit as snacks, or water given to on a daily basis, tooth brushing twice a day decrease the odds of caries in 3-year-olds. Diet appears to have primary significance in the etiology of ECC, since tooth brushing can only partly attenuate the impact of inappropriate dietary behaviors on dental caries. Children are more often caries-free and have lower severity of caries if their parents' dentition is self-assessed as healthy.

Community based programs to improve the oral health of Australian Indigenous adolescents: a systematic review and recommendations to guide future strategies

BACKGROUND

To review the international literature on community-based interventions aiming to improve the oral health of Indigenous adolescents and identify which demonstrate a positive impact.

METHODS

Data sources were MEDLINE, EMBASE, CINAHL, SCOPUS, the COCHRANE library and the Australian Indigenous HealthInfoNet. Articles were included where they: were published in English from 1990 onwards; described oral health outcomes for Indigenous adolescents aged 10 to 19 years; implemented a community based oral health intervention. The Quality Assessment Tool for Quantitative Studies from the Effective Public Health Practice Project was applied.

RESULTS

Nine studies met inclusion criteria; two rated strong in quality; only one study was conducted with an urban community; five reported moderate community engagement. Five intervention strategies were identified, and schools were the most common setting reported. Statistically significant improvements were described in eight studies with the most frequently reported outcome being change in decayed missing or filled teeth.

CONCLUSIONS

Few good quality peer reviewed international studies of community-based oral health interventions which address the needs of Indigenous adolescents exist. Studies must include strong Indigenous community leadership and governance at all stages of the research, adopt participatory action-based research approaches, and are required in urban communities.