Clinical Effectiveness and Cost-Effectiveness of Oral-Health Promotion in Dental Caries Prevention among Children: Systematic Review and Meta-Analysis

Oral health of Dutch primary school children in relation to social and health aspects

OBJECTIVE

This research investigated the oral health status of Dutch primary school children aged 10-12 years in Utrecht and its association with demographic characteristics, lifestyle factors, general psychosocial health, and dental treatment, to guide targeted interventions to improve children's oral and overall well-being.

MATERIALS AND METHODS

A cross-sectional survey was conducted at 49 primary schools in Utrecht in 2017 and 42 schools in 2019. The questionnaire covered background characteristics (7 questions), psychosocial health (14 questions), nutrition and exercise (20 questions), school and leisure time (26 questions), home situation (23 questions), and oral health (4 questions). Associations were analyzed using multivariate logistic regression.

RESULTS

Data from 5,426 children were analyzed. Prior to the survey, 11% did not visit a dentist, 23% had a toothache, 22% had a cavity filled, and 8% had a tooth extracted. Independent predictors for increased odds of oral health problems were migration background, poor general health, drinking more than two glasses of soft drinks per day, having ever drunk alcohol, having fear of failure, experiencing problems at home and/or coming from average or low socioeconomic position group. Factors associated with increased odds of dental treatment, such as cavity filled and tooth extracted, were migration background, fear of failure and home problems.

CONCLUSIONS

These findings emphasize the need for targeted prevention to improve the oral health of children with a migration background, average or low socioeconomic position and/or with poorer general and psychosocial health, unhealthy diets and problems in the home situation, within a community-based and transdisciplinary approach.

Oral hygiene behaviors and periodontitis among patients with chronic diseases and its impact on tooth loss and oral health-related quality of life: a cross-sectional study of data from the ComPaRe e-cohort

OBJECTIVES

Little is known about oral hygiene habits of patients suffering from chronic diseases. This study aims to describe oral hygiene behavior (OHB) in terms of tooth brushing and professional scaling frequency among patients with chronic diseases. Secondarily, it aims to assess the association between OHB and periodontitis, tooth loss, and oral health-related quality of life (OHRQoL).

MATERIALS AND METHODS

This is a cross-sectional analysis of data of adult participants in the ComPaRe e-cohort. Participants were classified into having good, moderate, and poor OHB according to self-reported frequency of toothbrushing and professional tooth scaling. Periodontitis was assessed using the PEriodontal Screening Score (PESS). Weighted binary regression models were used to estimate the association between OHB and the following outcomes: (i) periodontitis; (ii) number of missing teeth; and (iii) OHRQoL based on the Oral Health Impact Profile-14.

RESULTS

Overall, 8553 patients were included in the analyses (52.9% females, mean age of 56.3 ± 17 years). Of these, 2907 (34%), 3953 (46%) and 1693 (20%) were considered as having good, moderate, and poor OHB, respectively. Over half (54.1%) of the patients had a PESS ≥ 5 suggestive for severe periodontitis. Moderate OHB was associated with lower odds of PESS ≥ 5 compared to poor OHB (Adjusted Odds Ratio, OR = 0.81 [95%CI: 0.70-0.92]). Good and moderate OHB were significantly associated with lower odds of ≥ 10 missing teeth (OR = 0.26 [95%CI: 0.21-0.33] and OR = 0.47 [95%CI: 0.4-0.56], respectively) and better OHRQoL than poor OHB.

CONCLUSIONS

Although, most of patients with chronic diseases reported to have good or moderate OHB, severe periodontitis is highly prevalent among this patient population in France.

CLINICAL RELEVANCE

This study describes OHB in a representative sample of patients suffering from one or more chronic diseases and provides an estimate of the prevalence of self-reported severe periodontitis, missing teeth, and OHRQoL.

Barriers and Facilitators to Optimal Fluoride Varnish Application

OBJECTIVE

National guidelines recommend that all children under age six receive fluoride varnish (FV) in medical settings. However, application rates remain low. This study aimed to update understanding of barriers and facilitators to guideline concordant FV application.

METHODS

We conducted virtual semi-structured interviews with a purposive sample (eg, FV application rates, geographic location, practice size and type) of pediatric primary care clinicians and medical assistants in Massachusetts between February 1 and June 30, 2022. The Consolidated Framework for Implementation Research (CFIR) served as the study's theoretical framework and data were analyzed using a modified grounded theory approach.

RESULTS

Of the 31 participants, 90% identified as White and 81% as female. Major themes, which linked to four CFIR domains, included: variation in perceived adequacy of reimbursement; differences in FV application across practice types; variation in processes, protocols, and priorities; external accountability for quality of care; and potential levers for change. Important subthemes included challenges for small practices; role of quality measures in delivering guideline-concordant preventive oral health care; and desire for preventive care coordination with dentists.

CONCLUSIONS

This study suggests that potential barriers and facilitators to guideline concordant FV application exist at multiple levels that may warrant further study. Examples include testing the effectiveness of quality measures for FV application and testing strategies for implementing consistent processes and protocols for improving FV application rates.

A Study of the Association between Primary Oral Pathologies (Dental Caries and Periodontal Diseases) Using Synchrotron Molecular FTIR Spectroscopy in View of the Patient's Personalized Clinical Picture (Demographics and Anamnesis)

In this exploratory study, we searched for associations between the two most common diseases of the oral cavity-dental caries and periodontal diseases-taking into account additional factors, such as personalized clinical pictures (the individual risk factors of the patient), based on the method of a multivariate data analysis of the molecular changes in the composition of human gingival crevicular fluid (GCF). For this purpose, a set of synchrotron Fourier-transform infrared spectroscopy (FTIR) spectra of gingival crevicular fluid samples from patients with different demographics, levels of dental caries development and periodontal diseases, and the presence/absence of concomitant chronic diseases were obtained and analyzed. Using a set of techniques (v-, F-, Chi-square tests; a principal component analysis (PCA); and the hierarchical clustering of principal components (HCPCs)) implemented in the R package FactoMineR allowed us to assess the relationship between the principal components (PCs) and characteristics of the respondents. By identifying the features (vibrational modes in the FTIR spectra) that contribute most to the differentiation of the spectral dataset, and by taking into account the interrelationships between the patients' characteristics, we were able to match specific biological markers (specific molecular groups) to the two factors of interest-two types of oral pathologies. The results obtained show that the observed changes in the quantitative and qualitative composition of the modes in the infrared (IR) spectra of the GCF samples from patients with different dental caries developments and periodontal diseases present confirm the difficulty of identifying patient-specific spectral information. At the same time, different periodontal pathologies are more closely associated with other characteristics of the patients than the level of their caries development. The multivariate analysis performed on the spectral dataset indicates the need to take into account not only the co-occurrence of oral diseases, but also some other factors. The lack of this consideration (typical in lots of studies in this area) may lead to misinterpretations and consequently to a loss of data when searching for biological markers of certain oral diseases.

The role of community health workers in promoting oral health at school settings: A scoping review

OBJECTIVES

The scoping review aimed to examine the literature on the role of Community Health Workers (CHW) in oral health interventions within school settings. The objectives were to identify the characteristics of school oral health interventions where CHWs played a role; and to assess the outcomes derived from CHW participation in school oral health.

METHODS

The scoping review was guided by the Levac et al (2010) framework. Articles selected for this review included all forms of study designs and gray literature. The search strategy included CHW and other non-dental personnel providing oral health activities within schools and the outcomes of these interventions from 1995. Databases included Pubmed, ProQuest, Scopus and EBSCO Host.

RESULTS

There were eleven (n = 11) peer reviewed articles included. Only one study in this review related to CHW involvement in school oral health settings. The remaining involved teachers (n = 4), peer learners (n = 3) or a combination of both (n = 3). Characteristics of the interventions ranged from oral health screenings, education, supervised brushing, and community engagements. Three outcomes emerged; widening access to oral health services, acceptability of non-oral health personnel and learners in promoting oral health and improvement of oral health self-care.

CONCLUSIONS

The review brought to light the benefits of utilizing non-dental personnel such as teachers and peer learners in augmenting staff capacity for school oral health interventions. In addition, the findings highlighted the need to further research on the feasibility and acceptability of integrating CHW in school oral health settings.

Oral health of individuals with cerebral palsy in Saudi Arabia: A systematic review

OBJECTIVE

This systematic review aimed to comprehensively summarize and critically assess studies conducted on oral health outcomes among individuals with cerebral palsy (CP) in Saudi Arabia.

METHODS

This study followed the Participants, Exposure, Control and Outcomes (PECO) framework to formulate a focused research question. We conducted an extensive literature search across multiple databases, including PubMed, Medline, Scopus and Embase, in addition to clinical trial registers. Inclusion criteria encompassed clinical studies conducted in either English or Arabic, focusing on CP as defined by the International Classification of Diseases 10 (ICD10), and examining various oral health conditions and parameters. Nonclinical studies, commentaries, other systematic reviews and letters to the editor were excluded. Data extraction included comprehensive information about the study characteristics, oral health outcomes (dental, oral or periodontal disease; changes in standardized indices; dental trauma and other types of oral diseases) and an assessment of the risk of bias using the Appraisal Tool for Cross-Sectional Studies (AXIS).

RESULTS

The initial search yielded a total of 879 articles, ultimately resulting seven studies that met our stringent inclusion criteria. All of these studies were conducted as cross-sectional investigations in different cities within Saudi Arabia. The sample sizes ranged from 46 to 400 participants, all falling within the age range of 2-18 years. Notably, the prevalence of dental caries among individuals with CP in these studies varied significantly, with rates ranging from 52.9% to as high as 98.6%. Additionally, a substantial portion of CP patients exhibited poor oral hygiene, with figures ranging between 34.6% and 66.2%, and dental trauma was reported in 47.5% of the cases. Moreover, these studies underscored the influence of motor function and intellectual disabilities on the oral health status of CP individuals. Furthermore, various secondary outcomes, including periodontal parameters and oral health-related quality of life, were also assessed. However, it is essential to acknowledge that several sources of bias were identified within these studies, raising questions about the generalisability of their findings.

CONCLUSION

In conclusion, the systematic review revealed a concerning pattern of high dental caries prevalence and other oral health issues among individuals with CP in Saudi Arabia. Nevertheless, the need for comparative studies between CP patients and those without CP is evident to establish a definitive understanding of the oral health status of CP individuals. Initiating early interventions such as oral hygiene education, preventive dentistry programs, and orthodontic interventions could potentially contribute to improved oral health outcomes for individuals with CP in Saudi Arabia.

A Qualitative Study of Preschool Children's Perspectives on an Oral Health Promotion Program in New South Wales, Australia

In Australia, dental caries are observed in almost half of children starting school. Oral health promotion programs are being implemented in early childhood education and care (ECEC) settings to promote oral health. This study examined children's perceptions of one such program, the Bright Smiles Bright Futures (BSBF) program in ECEC settings in New South Wales, Australia. Data were collected using focus group discussions from 15 children aged 3-5 years, transcribed verbatim, and analysed through inductive thematic analysis. Three themes were identified as follows: (i) oral health knowledge of children, (ii) oral hygiene practices routine and skills development, and (iii) evaluation of the oral health promotion kit and opportunities for improvement. Children's perspectives highlight the BSBF program's success in communicating key messages to promote oral health. The integration of family-centric approaches, acknowledgement of children's preferences, and the use of interactive tools collectively enhance the overall effectiveness of the oral health promotion program.

Trends and age-period-cohort effect on dental caries prevalence from 2008 to 2019 among Brazilian preschoolers

This study aimed to evaluate trends in the prevalence of dental caries in preschool children and associated factors considering different time variations. This is a time series study performed using data from three cross-sectional studies with pre-school children from southern Brazil in 2008, 2013 and 2019. This children group was born between the years of 2003 to 2018. Dental caries was evaluated by decayed, missing and filled deciduous teeth (dmft index). Demographic, socioeconomic, behavioural and psychosocial variables were also collected. Chi-square test for trends and a hierarchical age-period-cohort (HAPC) analysis using multilevel Poisson regression model for testing the associations between predictor variables and dental caries experience were used. A total of 1,644 pre-school children participated in all surveys. There was a significant difference in caries experience considering all APC effects. The prevalence of dental caries was 25.0% in 2008, 16.3% in 2013, and 19.4% in 2019 (p < 0.01) and no statistical difference was observed. An age effect showed that older children were more likely to experience dental caries. Considering the cohort effect, there is a significant difference between the generations, mainly between 2003 and 2018. Household income, use of dental services, and parent's perception of child oral health were associated with dental caries experience no matter the time variation. Despite recent declines in dental caries prevalence among preschool children, caries levels increased with age and social inequalities persisted through the years, indicating a need of reviewing the policies to reduce the burden of this oral disease.

The gamification and development of a chatbot to promote oral self-care by adopting behavior change wheel for Taiwanese children

Background

Oral health is closely related to general health and quality of life. School-aged children are at a critical stage for developing their self-care ability in oral health. Digital interventions can encourage and facilitate oral self-care in children.

Objective

This study aims to present the development of an educational chatbot for school-aged children to address their oral self-care and evaluate its usability.

Methods

The development and evaluation of the chatbot for oral self-care consisted of four stages: target behavior analysis, intervention design, system development, and the chatbot evaluation. The target behavior analysis identified barriers to children's engagement in oral self-care based on dentists' clinical observations; hence, the requirements for achieving the desired behavior were categorized according to the capability-opportunity-motivation behavior model. Interventional functions were created following the behavior change wheel. A menu-driven chatbot was created and evaluated for usability as well as likeability.

Results

The barriers and requirements for achieving good behavior in school-aged children's oral self-care were identified by the dental professionals. Intervention strategy incorporated specific functions enriched with gamification features to support school-aged children in developing their abilities for engaging in oral self-care. The intervention functions consist of capability establishment, motivation enhancement, and opportunity creation, which were designed to support children in their oral self-care practices. The designed chatbot was piloted with a convenient sample of 30 school-aged children and their accompanying parents at the pediatric dental clinic. The results indicated good usability, with a mean usability score of 79.91, and high likeability with a mean score of 4.32 out of 5 for the designed chatbot.

Conclusions

The educational chatbot incorporated a combination of clinical dentistry practice and guidelines, aiming to promote oral self-care behavior in school-aged children. The designed chatbot achieved high scores for its usability and user likability.

Influence of sociodemographic factors and Family Health Strategy coverage on oral health promotion procedures: an analysis of Brazilian municipalities in 2019

Background

The aim of the study was to investigate associations between sociodemographic factors and municipal Family Health Strategy (FHS) coverage and oral health promotion (OHP) procedures in Brazil.

Material and Methods

Data were obtained using public information systems and by direct request to the Ministry of Health. Clinical and collective OHP procedures performed in 2019 were analyzed, and sociodemographic covariates were associated with FHS coverage (population covered by FHS teams [FHST] and oral health teams [OHT]). Negative binomial regression models associated outcomes with covariates and estimated the prevalence ratio (PR) and confidence intervals (95%CI).

Results

A total of 4,913 municipalities were included. Municipalities with low-income inequality (PR=1.04, 95%CI 1.01 to 1.08), high illiteracy rate (RP=1.06, 95%CI 1.00 to 1.13), and population size of 10,001 to 50,000 inhabitants (PR=1.07, 95%CI 1.02 to 1.12) and 50,001 to 100,000 (PR=1.21, 95%CI 1.12 to 1.30) showed a higher frequency of clinical procedures. In contrast, a low frequency of clinical procedures was associated with reduced vulnerability to poverty (PR=0.83, 95%CI 0.78 to 0.89) and low OHT coverage (PR=0.39, 95%CI 0.33 to 0.45). Regarding collective procedures, the final model showed associations between low frequency and reduced income inequality (PR=0.91, 95%CI 0.87 to 0.95), low per capita income (PR=0.84, 95%CI 0.81 to 0.88), and low (PR=0.53, 95%CI 0.35 to 0.80) and medium Human Development Index (PR=0.79, 95%CI 0.71 to 87).

Conclusions

Clinical and collective OHP procedures were associated with sociodemographic conditions and OHT coverage in the FHS. Key words:Health Promotion, Oral Health, Social Determinants of Health, Universal Health Coverage.

Improving Oral Health with Fluoride-Free Calcium-Phosphate-Based Biomimetic Toothpastes: An Update of the Clinical Evidence

As the demand for clinically effective fluoride-free oral care products for consumers increases, it is important to document which types of toothpastes have been shown in clinical studies to be effective in improving oral health. In this review, we included different indications, i.e., caries prevention, improving periodontal health, reducing dentin hypersensitivity, protecting against dental erosion, and safely improving tooth whitening in defining what constitutes improvement in oral health. While there are several professional and consumer fluoride-containing formulations fortified with calcium-phosphate-based ingredients, this review focuses on fluoride-free toothpastes containing biomimetic calcium-phosphate-based molecules as the primary active ingredients. Several databases were searched, and only clinical trials in human subjects were included; in vitro and animal studies were excluded. There were 62 oral health clinical trials on biomimetic hydroxyapatite (HAP), 57 on casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), 26 on calcium sodium phosphosilicate (CSPS, or so called Bioglass), and 2 on β-tricalcium phosphate (β-TCP). HAP formulations were tested the most in clinical trials for benefits in preventing caries, dentin hypersensitivity, improving periodontal health, and tooth whitening. Based on the current clinical evidence to date, fluoride-free HAP toothpaste formulations are the most versatile of the calcium phosphate active ingredients in toothpastes for improving oral health.

A Scoping Review of Economic Evaluations to Inform the Reorientation of Preventive Health Services in Australia

The Australian National Preventive Health Strategy 2021-2030 recommended the establishment of evidence-based frameworks to enable local public health services to identify strategies and interventions that deliver value for money. This study aimed to review the cost-effectiveness of preventive health strategies to inform the reorientation of local public health services towards preventive health interventions that are financially sustainable. Four electronic databases were searched for reviews published between 2005 and February 2022. Reviews that met the following criteria were included: population: human studies, any age or sex; concept 1: primary and/or secondary prevention interventions; concept 2: full economic evaluation; context: local public health services as the provider of concept 1. The search identified 472 articles; 26 were included. Focus health areas included mental health (n = 3 reviews), obesity (n = 1), type 2 diabetes (n = 3), dental caries (n = 2), public health (n = 4), chronic disease (n = 5), sexual health (n = 1), immunisation (n = 1), smoking cessation (n = 3), reducing alcohol (n = 1), and fractures (n = 2). Interventions that targeted obesity, type 2 diabetes, smoking cessation, and fractures were deemed cost-effective, however, more studies are needed, especially those that consider equity in priority populations.

Oral Health in migrants children in Melilla, Spain

Numerous developing countries' socioeconomic and political issues resulted in a significant migratory phenomenon, which poses a health burden for the nations that receive migrant populations. Often, the greatest age group of migrants is children and teens. Oral problems are one of the most common reasons that immigrants in the receiving nations visit the healthcare system. Cross-sectional research was conducted on children and teenagers housed at the Temporary Stay Center for Immigrants (CETI) of the Autonomous City of Melilla (Spain) with the aim of identifying the state of the oral cavity of these group of migrants. Information on the condition of the research group's oral cavity was gathered using the World Health Organization's standards. The research comprised all of the children and teenagers who were enrolled in the CETI for a defined period of time. A total of 198 children were assessed. It was determined that 86.9% of the youngsters were of Syrian descent. There were 57.6% males and a 7.7 (±4.1) average age. The average caries index for children under the age of six was dft =6.4 (±6.3), and for children aged six to eleven, it was 7.5 (±4.8), taking into account both the temporary and permanent dentition, and for children aged twelve to seventeen, it was 4.7 (±4.0). A total of 50.6% of children between the ages of 6 and 11 needed extractions, compared to 36.8% of children under the age of 6. The population under study had a significant incidence of sextants where bleeding occurred during periodontal probing (mean 3.9 (±2.5)), according to an examination of the community periodontal index (CPI). It is crucial to study the oral cavity status of refugee children when designing intervention programs to improve their oral health and provide health education activities that favour the prevention of oral diseases.

Comparing knowledge and opinions of medical and dental students in the field of pediatric anesthesia

Background and Purpose

Dental treatment under general anesthesia (GA) is one of the common treatment methods today for dental treatment in children, so dentists' point of view in this field is very important. Therefore, the purpose of this study was evaluation the awareness and attitude of pediatric dentists and final-year dental students about dental treatment for children under GA.

Methods

To conduct this study, 150 people, including 75 general dentists (GD) and 75 final-year dental students (FYDS), were randomly selected in Tehran. In this study, a researcher-made questionnaire containing 15 questions (7 awareness questions and 8 attitude questions) was used to evaluate the awareness and attitude of the participants. After extracting the raw results, statistical analysis of the results was done using SPSS-Ver. 22 software.

Results

60% of the participants (90 people) were men and the remaining 40% (60 people) were women. The results showed that the level of awareness of male dentists was significantly higher than that of female dentists (P = 0.015). In addition, although the awareness level of FYDS was lower than GD, this difference was not statistically significant (P = 0.130). The average level of awareness among different age groups had a significant difference (P = 0.009), so the age group of 36-45 years compared to the younger age groups (25-35 years) and the older age groups (36-45 and 55 -46 years), had a higher level of awareness.

Conclusion

According to the findings, it can be concluded that it is necessary to use appropriate educational methods to improve the level of awareness and attitude of children's dentists.

Parent's self-reported tooth brushing and use of fluoridated toothpaste: Associations with their one-year-old child's preventive oral health behaviour

OBJECTIVE

The aim of the study was to examine if the tooth brushing frequency and use of fluoridated toothpaste of the mother and father were associated with the tooth brushing frequency and use of fluoridated toothpaste for their 1-year-old child.

METHODS

This cross-sectional study is part of the FinnBrain Birth Cohort Study. Questionnaire data were obtained from 1672 mothers and 867 fathers on tooth brushing and use of fluoridated toothpaste, age, education, number of siblings and parity (when the child was 1-year-old). For 763 families (mother and father), data from both parents were available. Tooth brushing was dichotomized to at least twice daily (2× day) and less than 2× day, and use of fluoridated toothpaste for child to at least once daily and less than once daily. The association between brushing of child's teeth (both parents less than 2× day) and use of fluoridated toothpaste for the child (both parents less than once daily) with parent's own tooth brushing was modelled with logistic regression analyses adjusted for family-related variables (parents' age and education, number of older siblings) using odds ratios (OR) and 95% confidence intervals (CI).

RESULTS

Families in which both parents brushed their own teeth less than 2× day were more likely to brush their child's teeth less than 2× day than families in which both parents brushed their own teeth 2× day (OR = 9.23; 95%CI = 5.42-15.69). The likelihood of not brushing the child's teeth 2× day was less strong when at least one of the parents brushed his/her own teeth 2× day (mother 2× day: OR = 1.97; 95%CI = 1.25-3.10; father 2× day: OR = 2.85; 95%CI = 1.51-5.40).

CONCLUSIONS

Less frequent tooth brushing of both mothers and fathers was strongly associated with less frequent tooth brushing of their child. When educating parents on child oral home care, parents' own home care and inclusion of fathers also need more attention.

The importance of promoting oral health in schools: a pilot study

Promotion of oral health has an essential role in the maintenance of teeth in adults. However, health education must start from an early age, in order to monitor the child's growth and prevent pathologies. Schools are in charge of the overall education of children and of guidance to parents but could also be engaged in the promotion of oral health, supported and counseled by pediatricians and dentists. The purpose of this pilot study is to evaluate whether school age children could be taught, successfully, basic oral sciences and dental hygiene, by a professional, during school hours. In this pilot study, an anonymized test was administered to 45 children of age between 8 and 10, both before and after an interactive lecture on oral health, to assess the effectiveness of the lesson and acquisition by the children of knowledge on oral health. After the presentation, the majority of the children were able to answer correctly to the questionnaire that was given to them (test, retest) which was related to dental anatomy and pathology (number of teeth, cavities, halitosis), and dental hygiene tools and practices (brushes, floss, mouth wash, tongue scrapers). The children seemed to be receptive to learning while in school, and a specific educational session of dental hygiene and oral health seems to be the right approach to ensure children can identify dental hygiene tools and use them appropriately.

Caries Experience and Risk Indicators in a Portuguese Population: A Cross-Sectional Study

Oral health surveys are essential for assessing the dental caries experience and to influence national policies. This retrospective cross-sectional study aims to analyze dental caries experience for which dental treatment was sought in a reference university dental hospital at the Lisbon Metropolitan Area between January 2016 and March 2020. Full-mouth examination, and sociodemographic, behavior, and medical information were included. Descriptive analyses and logistic regression analysis were applied to ascertain risk indicators associated with dental caries experience. A final sample of 9349 participants (5592 females/3757 males) were included, aged 18 to 99 years old. In this population, caries experience was 91.1%, higher in female participants. Age (OR = 1.01, 95% CI [1.00-1.02], occupation (OR = 2.94, 95% CI [2.37-3.65], OR = 3.35, 95% CI [2.40-4.67], OR = 2.55, 95% CI [1.66-3.91], for employed, unemployed, and retired, respectively), overweight (OR = 1.52, 95% CI [1.18-1.96]), reporting to have never visited a dentist (OR = 0.38, 95% CI [0.23-0.64], and self-reported week teeth status (OR = 2.14, 95% CI [1.40-3.28]) were identified as risk indicators for the presence of dental caries, according to adjusted multivariable logistic analyses. These results highlight a substantial rate of dental experience in a Portuguese cohort and will pave the way for future tailored oral public health programs in Portugal.

Economic Evaluations of Preventive Interventions for Dental Caries and Periodontitis: A Systematic Review

OBJECTIVES

To critically examine the methods used for full economic evaluations of preventive interventions for dental caries and periodontitis.

METHODS

Published literature post-2000 was searched to April 2021. Based on a developed intervention classification framework for dental caries and periodontitis, only universal, selective or indicated interventions were included in this review. The Drummond 10-point checklist was used for quality appraisal.

RESULTS

Of 3,007 unique records screened for relevance, 73 studies were reviewed. Most model-based studies (61/73) used cost-effectiveness analysis (49%) or cost-benefit analysis (28%). Trial-based studies (16/73) commonly used cost-effectiveness analysis (59%). Four studies used both economic evaluation methods. Sixty-four papers (88%) were on dental caries, eight papers (11%) focused on periodontitis, and one paper (1%) included both oral diseases; 72% of model-based and 82% of trial-based studies were of good quality. The most frequently investigated dental caries preventive interventions were water fluoridation (universal intervention; cost-saving or cost-effective), fissure sealant and fluoride varnish (selective and indicated interventions; cost-effectiveness outcomes were inconsistent). Supportive periodontal therapy with oral health education (indicated intervention; cost-effective) was the most frequently evaluated preventive intervention for periodontitis. Thirty percent of studies with a time horizon > 1 year did not apply an appropriate discount rate and 26% did not comprehensively discuss other important considerations beyond the technical analysis.

CONCLUSIONS

Generic health outcome measures should be incorporated for economic evaluations on preventive interventions for dental caries and periodontitis, and an increased focus to prevent periodontitis using economic evaluation methods is needed to inform resource allocation and policy decision-making.

Is It Mum or the Dad? Parental Factors That Influence the Use and Acceptance of Fluoride Varnish among Parents in Eastern Saudi Arabia

Objective

To investigate parental factors that influence knowledge, use, and acceptance of fluoride varnish (FLV) application.

Methods

This cross-sectional study was conducted during December 2021. A multistage sampling technique was used to recruit parents with children aged 3 to 6 years and residing in Eastern Saudi Arabia, excluding those working in the dental field. The questionnaire consisted of four parts: demographics, knowledge, previous experience, and acceptance of FLV and was pilot-tested and distributed online using social media.

Results

A total of 623 parents responded to the survey. Only 36.9% of parents had good FLV knowledge with dentists being the main source of information. Gender, educational level, family income, being in the medical field, and source of knowledge were factors that significantly (P < 0.05) influenced parental knowledge. Only 24.6% of the parents applied fluoride varnish to their children before, of whom only 29% were satisfied with the experience. Parent's FLV knowledge, view of dental visits, satisfaction with previous experience, perception of children's oral health, and willingness to reapply FLV were factors that significantly (P < 0.05) influenced FLV use. Working in the medical field, perception of dental visits, and the source of knowledge were factors that significantly (P < 0.05) influenced the parent's acceptance to apply FLV. While lack of knowledge about fluoride benefits (15%) was the main reason for parental refusal to apply FLV.

Conclusions

The current study highlights the lack of knowledge and application of FLV among parents. There were more factors influencing mothers' acceptance of FLV application compared to fathers. Age, educational level, working in the medical field, perception, and patterns of dental visits were some of the identified factors. Dentists played a major role in parental knowledge and FLV acceptance. In a country with high caries prevalence, preventive programs such as FLV education and application are crucial.

Implementação do Programa Saúde na Escola: relação com aspectos da saúde bucal dos estudantes

RESUMO O estudo objetivou investigar a associação entre a implementação do Programa Saúde na Escola (PSE) e aspectos relacionados com a saúde bucal de adolescentes escolares que frequentam escolas públicas no Brasil. Foi realizado estudo transversal exploratório utilizando dados da Pesquisa Nacional de Saúde Escolar (PeNSE) 2015 em uma amostra de 81.154 estudantes de 13 a 15 anos frequentando escolas públicas das capitais, Distrito Federal e interior. Os dados foram obtidos por meio de questionários respondidos pelos alunos e responsáveis pelas escolas. Foi realizada análise bivariada de associação entre a variável ‘implementação das ações do PSE pela escola’ (Sim/Não) e aspectos relativos à saúde bucal dos estudantes. Em comparação com escolas sem implementação do PSE, as que haviam implementado o Programa apresentavam melhores indicadores de comportamento (consumo de alimentos com açúcar adicionado, cigarro e álcool); venda de alimentos saudáveis ou com açúcar adicionado; existência de grupo/comitê de saúde, ações do Programa Mais Educação e ações em conjunto com a Unidade Básica de Saúde (p<0,05). Concluiu-se que houve associação entre a implementação do PSE e aspectos mais favoráveis relacionados com a saúde bucal, referentes a alimentação, uso de cigarro e álcool entre os escolares, e ações de saúde e educação nas escolas.

Implementation of the School Health Program: relationship with aspects of students’ oral health

ABSTRACT This study aimed to investigate the association between the School Health Program (PSE) implementation and aspects related to the oral health of adolescent students attending public schools in Brazil. An exploratory cross-sectional study was conducted using data from the 2015 National School Health Survey (PeNSE) in a sample of 81,154 students aged 13 to 15 in the capitals, Federal District, and inland cities. Data were retrieved from questionnaires answered by students and those responsible for the schools. We performed a bivariate analysis of the association between the variable ‘implementation of PSE actions by the school’ (Yes/No) and aspects related to the students’ oral health. Compared to schools without PSE implementation, those that had implemented the Program had better behavioral indicators (consumption of sugar-added foods, cigarettes, and alcohol); selling healthy or sugar-added foods; availability of a health group/committee, and actions of the More Education Program and with Primary Health Care Units (p<0.05). We concluded that there was an association between the implementation of the PSE and more favorable aspects related to oral health regarding the students’ diet, tobacco use, and alcohol consumption, and school health and education actions.

Comparative inequalities in child dental caries across four countries: Examination of international birth cohorts and implications for oral health policy

Child dental caries (i.e., cavities) are a major preventable health problem in most high-income countries. The aim of this study was to compare the extent of inequalities in child dental caries across four high-income countries alongside their child oral health policies. Coordinated analyses of data were conducted across four prospective population-based birth cohorts (Australia, n = 4085, born 2004; Québec, Canada, n = 1253, born 1997; Rotterdam, the Netherlands, n = 6690, born 2002; Southeast Sweden, n = 7445, born 1997), which enabled a high degree of harmonization. Risk ratios (adjusted) and slope indexes of inequality were estimated to quantify social gradients in child dental caries according to maternal education and household income. Children in the least advantaged quintile for income were at greater risk of caries, compared to the most advantaged quintile: Australia: AdjRR = 1.18, 95%CI = 1.04–1.34; Québec: AdjRR = 1.69, 95%CI = 1.36–2.10; Rotterdam: AdjRR = 1.67, 95%CI = 1.36–2.04; Southeast Sweden: AdjRR = 1.37, 95%CI = 1.10–1.71). There was a higher risk of caries for children of mothers with the lowest level of education, compared to the highest: Australia: AdjRR = 1.18, 95%CI = 1.01–1.38; Southeast Sweden: AdjRR = 2.31, 95%CI = 1.81–2.96; Rotterdam: AdjRR = 1.98, 95%CI = 1.71–2.30; Québec: AdjRR = 1.16, 95%CI = 0.98–1.37. The extent of inequalities varied in line with jurisdictional policies for provision of child oral health services and preventive public health measures. Clear gradients of social inequalities in child dental caries are evident in high-income countries. Policy related mechanisms may contribute to the differences in the extent of these inequalities. Lesser gradients in settings with combinations of universal dental coverage and/or fluoridation suggest these provisions may ameliorate inequalities through additional benefits for socio-economically disadvantaged groups of children.

A model for implementing oral health-promoting school: Integration with dental students' educational curriculum: A protocol study

BACKGROUND

Schools are ideal setting for children's oral health-promoting programs. It is an integrated model for oral health-promoting schools (OHPS) with the capacities of dental school's curriculum and dental students as workforces. In this protocol, the principle of planning and implementation of the oral health program is described.

MATERIALS AND METHODS

Based on the PRECEDE-Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development (PROCEED) planning model, a framework for determining the potential predisposing, reinforcing, and enabling factors that could be intervening was diagnosed. To adapt the phases of the planning model for integration of the "OHPS" principles and the dental students' curriculum, the following steps are supposed to be considered: Phases 1-5 which are to assess the baseline data will include the assessment of children oral health status and parents and teachers' knowledge, attitude, and performance. Phase 6 or implementation phase will be allocated to oral health education interventions for students, parents, and teachers, professional screening, prevention, and referral. Phase 7 or the process assessment phase will be to record the number of screened students, the amount of fissure sealant and fluoride provision, and percentage of trained parents and teachers. Phase 8 or the impact assessment phase will assess the students' improvement in knowledge and practice, decayed, missing, and filled teeth scores, teachers and mothers' oral health attitudes and behaviors, and brushing and flossing behaviors. At the last, cost analysis of the program and long-term monitoring of the interventions is suggested.

CONCLUSION

In case that the effectiveness of this model is proven, it can be implemented by other dental schools for the primary schools in their regions. Considering the number and distribution of dental schools in the country, this model is executable as targeted population oral health promotion approach in 6-12-year-old schoolchildren.

Economic analysis of the different endodontic instrumentation techniques used in the Unified Health System

BACKGROUND

To assess the financial impact of incorporating a new (reciprocal) technology into endodontic treatments in the public health system (SUS).

METHODS

This was a economic evaluation study (comparing the 3 different endodontic instrumentation techniques-manual, rotary and reciprocating), allocative efficiency analysis to optimize existing resources in the SUS, and financial contribution impact analysis of incorporation of a new technology. Thirty-one (31) 12 years-old volunteers were evaluated.

RESULTS

The incremental cost-effectiveness ratio (ICER) was calculated at R$1.34/min, - R$0.60/min and BRL 0.10/min for the single-rooted, bi-rooted and tri-rooted teeth, respectively, when the rotary technique was compared with the manual type. In turn, the ICER was R$ 21.04/min, - R$ 0.73/min and - R$ 2.81/min for the 3 types of teeth, respectively, when the reciprocating technique was compared with the manual type. The incremental financial impact of replacing manual endodontic with rotary endodontic treatments would be - R$ 2060963.66 in the case of single-rooted teeth, but the number of treatments would also be reduced (- 19,379). In the case of two-rooted teeth, the incremental financial impact would be BRL 34921540.62 with the possibility of performing an additional 204,110 treatments. In turn, BRL 11523561.50 represented the incremental financial impact for teeth with 3 or more roots and with an increase of 72,545 procedures. When we analyzed the incremental financial impact of replacing manual endodontic with reciprocating endodontic treatments, it would be - R$ 730227.80 in the case of single-rooted teeth, allowing for an additional 2538 treatments. In turn, R$ 21674853.00 represented the incremental financial impact for bi-radicular teeth, with an increase of 121,700 procedures. In the case of two-rooted teeth, the incremental financial impact would be BRL 13591742.90 with the possibility of performing an additional 40,670 treatments.

CONCLUSIONS

The reciprocating technique could improve access to endodontic treatment in the SUS as it allowed a simultaneous reduction in clinical time and associated costs. However, the higher number of endodontic treatments performed would have a financial impact.

Oral health status and practices of 6- to 7-year-old children in Amman, Jordan: a cross-sectional study

Background

Dental caries affects the majority of children in Jordan, with some evidence of its prevalence steadily increasing. Previous studies have shown that families struggle to establish good oral health practices. The aim of this study was to evaluate the current oral health status and practices of 6- to7-year-old children in Amman, Jordan.r

Methods

A cross-sectional cohort study. The sample consisted of 6- to 7-year-old children attending six randomly selected schools in Amman, Jordan. Measures collected were: I) Caries experience (d3mft/D3MFT), II) Oral hygiene, measured using the Simplified Oral Hygiene Index, III) Dietary, toothbrushing, and dental attendance practices, measured using diaries and parental questionnaires, IV) Participants’ basic characteristics: age, education and employment. Data were analysed using SPSS20.

Results

In total, 942 children were recruited. Four hundred and fifty-seven were boys, 485 were girls. Their average age was 6.5 years. Eighty-nine percent had decay in their primary teeth. Mean d3mft was 5.1(1 (range = 0–12, SD = 2.9). Only 8% of carious teeth were restored. Mean DMFT score was 0.3 (range = 0–4, SD = 0.8). Mean debris score was 1.07 (range = 0–3, SD = 0.37). Children indicated that they brush their teeth 1.6 times a day (range = 0–3, SD = 0.6). The majority (81%) were unsupervised. Sixty-seven percent of parents did not know the appropriate fluoride toothpaste concentration. Children were having 1.5 sugary snacks in-between their meals (Range = 1–6, SD = 1.1). They scored a mean of 2.5 (Range = 0–5.87, SD = 1.7) in sweetened drinks intake (recommended ≤ 1) and 2.8 (Range = 0–18.57, SD = 1.5) in non-core food intake (recommended ≤ 2) on a dietary questionnaire. Most parents (84%) indicated that their child attends the dentist only when in pain, and 18% indicated that their child is extremely afraid of dentists. Only 32% and 18% were familiar with fluoride varnish and fissure sealants, respectively. Regression analysis revealed that debris score and dental attendance were reliable predictors of caries experience.

Conclusions

Six- to seven-year-old children in Amman, Jordan have a high caries experience. Most show signs of poor oral hygiene, excessive intake of cariogenic foods, and symptomatic dental attendance. Their parents lack knowledge on fluoride varnish and fissure sealants. There is a need for oral health promotion tailored to this cohort's need.

Evaluation of the Cause of Dental Treatment in Children under General Anesthesia from the Perspective of Pediatric Dentists and Postgraduate Students and Parents of Children under General Anesthesia at the Dentistry School of Tehran University of Medical Science

Background

Nowadays, dental treatment under general anesthesia is accepted as a treatment method in children in which other common methods do not allow to achieve acceptable results. The benefits of general anesthesia in pediatric dental treatment are that the treatment is completed in one session, the person is relieved of pain, and most importantly, the child does not need to cooperate. However, it is important to determine the exact dental reasons for children under general anesthesia.

Objective

In this study, the cause of dental treatment under general anesthesia in children was examined from the perspective of specialists, assistants, and parents of children under general anesthesia.

Methods

In this descriptive-analytical cross-sectional study, participants were selected from among the parents of children under general anesthesia for dental treatment and pediatric dentists and assistants in a purposeful manner. After the items were prepared by the professors, the prepared checklist was read to the people. After completing the checklist, the data were entered into SPSS software version 20 and analyzed using descriptive statistics such as frequency determination, mean, and statistical rests.

Results

According to the consensus of parents and experts, the main reasons for general anesthesia for children to perform their dental operations were: young age, lack of cooperation during previous dental treatment, a large number of dental treatments, systemic disease of the child, unwillingness of parents to perform behavioral control procedures, higher quality work under anesthesia, mental and physical behavioral problems, and reduced number of treatment sessions.

Conclusion

Therefore, reasons such as young age, lack of cooperation, and a large number of dentist's work are among the most important factors that lead to the decision to perform general anesthesia in children. In light of this decision, the consequences and disadvantages/advantages of this method are important and therefore more research should be done on this issue.

An educational intervention using the health belief model for improvement of oral health behavior in grade-schoolers: a randomized controlled trial

Background

Oral health problems especially dental caries are common in school children, and education programs may help to prevent these conditions. The aim of current study was to examine the effects of an educational program based on a Health Belief Model (HBM) to improve oral health behaviors of elementary school children.

Methods

A total of 112 children ages 6–12 years old accompanied by one of their parents were randomly assigned to intervention/test and control groups. In the intervention group, five consecutive weekly educational sessions based on the HBM were provided, while the control group received only routine education delivered by the dental clinic. The Decayed, Missing, and Filled Teeth (DMFT) score, papillary bleeding index, and responses to the HBM questionnaire were assessed in the intervention and control groups at baseline and three-month follow-up after the intervention was completed. Within-group and between-group differences were examined using the Student’s t-test and analysis of covariance.

Results

All HBM domains were improved at follow-up in the intervention group compared to the control group (p < 0.001). The largest change was in perceived susceptibility, whereas the smallest changes were in perceived severity and perceived benefits. The papillary bleeding index demonstrated a significant change from baseline to follow-up in the intervention group (reduction of 0.7, 95% CI = − 0.9 to − 0.5). All components of the DMFT score except missing teeth also improved in the intervention group compared to controls. However, no significant difference was found in total DMFT score between intervention and control groups.

Conclusion

An education program based on HBM may be more effective than current methods used to educate children and their parents on optimal oral health behaviors. Administration of interventions of this type along with other school-based programs to prevent dental caries may be helpful in grade-school children.

Development and Validation of an Oral Health Literacy Measurement for Primary School Children in Thailand

Background

Oral health promotion programs have been implemented in primary schools for many years in Thailand. Oral health literacy has been introduced as a health promotion outcome; however, no assessment tool has been developed for this age group. The objective of this study was to develop and validate the Test of Functional Health Literacy in Dentistry for Primary School Children (P-TOFHLiD). Materials and Methods. The P-TOFHLiD was developed by modifying contents and outlines using a previously validated tool for older adults, then verified by two experts for face validity. A cross-sectional study was conducted with samples collected from 118 grade-six students from two government schools in Chiang Mai Province, Thailand. The P-TOFHLiD and a previously validated word recognition test were administered, followed by oral examination to assess reliability, concurrent validity, convergent validity, and predictive validity and establish the cut-off score of the tool. The statistical analysis was performed using SPSS version 25.

Results

The internal reliability of P-TOFHLiD was good (α = 0.808). The correlation coefficient between the P-TOFHLiD and grade point average was 0.478 (p value <0.001), which is the represented concurrent validity of the tool. Coefficients between P-TOFHLiD and a word recognition test was 0.422 (p-value <0.001) for convergent validity. P-TOFHLiD was significantly correlated with the number of missing teeth from tooth decay (p-value <0.05), but the correlation coefficient was poor (r = −0.100). The cut-off scores for adequate oral health literacy were set at ≥21 out of the total scores of 26.

Conclusion

P-TOFHLiD presented good validity and reliability and was ready to use for oral health promotion program evaluation. However, the predictive validity of the P-TOFHLiD in predicting oral health status was questionable only.

Neighborhood-Level Inequalities in Dental Care of Adolescents and Young Adults in Southwestern Ontario

We examined whether the association of neighborhood-level socioeconomic status (SES) with the cost of dental care and dental care outcomes differs between adolescents and young adults. A total of 2915 patient records were split into two groups: adolescents (15 to 17 years of age) and young adults (18 to 24 years of age). Three dental care outcomes—routine oral evaluation (OEV-CH-A), utilization of preventive services (PRV-CH-A), and dental treatment services (TRT-CH-A)—were determined according to the Dental Quality Alliance (DQA) criteria. Associations of neighborhood SES and other sociodemographic variables with dental care outcomes and the cost of dental care were assessed using binary logistic and univariate linear regression models, respectively. Young adults had significantly lower PRV-CH-A and higher TRT-CH-A scores when compared to adolescents. We observed a significant negative association between TRT-CH-A and median household income in both adolescents and young adults. Utilization of dental treatment services was positively associated with the cost of care in both age groups, whereas utilization of preventive services was inversely associated with the cost of care in young adults, but not in adolescents. Neighborhood-level income was inversely associated with increased TRT-CH-A in both young adults and adolescents. In summary, young adults showed significantly worse preventive and treatment outcomes when compared to adolescents. Moreover, individuals from neighborhoods with a lower household income showed a significantly higher cost of dental care, yet worse treatment outcomes.

Effects of Silver Diamine Nitrate and Silver Diamine Fluoride on Dentin Remineralization and Cytotoxicity to Dental Pulp Cells: An In Vitro Study

Silver diamine nitrate (SDN) is expected to help control caries similar to silver diamine fluoride (SDF). The aim of this study was to determine the mineral precipitation in demineralized dentin and the cytotoxicity of SDN and SDF to dental pulp cells. Demineralized dentin specimens were prepared, and SDF, SDN, or water (control) was applied. The specimens were then remineralized in simulated body fluid for 2 weeks. The mineral precipitation in the specimens was examined using FTIR-ATR, SEM-EDX, and synchrotron radiation X-ray tomographic microscopy (SRXTM). Additionally, the cytotoxicity of SDF and SDN to human dental pulp stem cells was analyzed using an MTT assay. The increase in FTIR spectra attributable to apatite formation in demineralized dentin in the SDF group was significantly higher compared to the SDN and control groups (p < 0.05). Dentinal tubule occlusion by the precipitation of silver salts was detected in both SDF and SDN groups. The mineral density as shown in SRXTM images and cytotoxicity of both SDN and SDF groups were comparable (p > 0.05). In conclusion, SDF demonstrated superior in vitro apatite formation compared to SDN. However, the degree of mineral precipitation and cytotoxic effects of both were similar.

Oral health in a context of public health: prevention-related issue

This publication analyses current literary knowledge on selected topics in the fields of oral health and pathology, with a particular emphasis on the potential roles of the oral microbiome and preventative approaches to oral afflictions. An important association with floral dysbiosis has been documented in important oral conditions, sometimes as a predisposing factor and at other times as a result thereof. However, much remains to be elucidated regarding the specific mechanisms at play, as well as their meaning in clinical practice. Continued research into the pathophysiology of certain oral diseases is of particular importance considering how widespread they are. A specific emphasis should be placed on understanding the exact mechanisms through which the microbiota facilitates health, and when disturbed, sickness. And perhaps of most importance is the implementation of knowledge already acquired on disease prevention if the burden of oral diseases worldwide is to decline in the future.

Are they ready? Awareness and preparedness of the emerging workforce for Dental Check by One

Background Dental Check by One (DCby1) is a British Society of Paediatric Dentistry campaign, which aims to increase dental attendance of young children. As the future workforce, dental students have a key role in ensuring its long-term success.Aims To establish final-year dental students' awareness of DCby1. To evaluate their preparedness for providing dental care for young children and to identify perceived barriers to doing so at the time of graduation as they prepare to enter the workforce.Materials and methods An anonymous, online survey was administered to graduating final-year dental students in 2018, 2019 and 2020. Quantitative data were gathered using mixed item formats and Likert scales. Qualitative data were also gathered using free-text questions, allowing evaluation of the opinions of responders.Results The response rate was 83% (n = 63) in 2018, 91% (n = 62) in 2019 and 73% (n = 57) in 2020. Eight percent (n = 5) of responders were aware of DCby1 in 2018, improving to 67% (n = 38) in 2020. Each year, 98% to 100% of responders felt prepared to provide preventive care for young children. Fewer than 60% felt prepared to provide breastfeeding and weaning advice to parents. Responders felt unprepared to examine the dentition of a preschool child. Undergraduate curricula and social media were identified as preferable sources of public health campaign information for students.Conclusion Awareness and preparedness for DCby1 appears to be improving. Ninety-five percent of all responders across three years of study felt prepared to examine a child aged under one year and this is encouraging for the long-term success of DCby1. Targeted curriculum reform including both didactic teaching and online learning platforms appears to have been pivotal to improving undergraduate awareness and preparedness. Social media may offer opportunities for engaging with undergraduate learners.

Universal oral health coverage - Perspectives from a developing country

Universal Health Coverage (UHC) is where people have access to health services without suffering financial hardship to pay for it, provide equitable health-care services that are appropriate, accessible and affordable for all people, particularly poor and disadvantaged communities. However, optimal intervention in relation to oral disease is not universally available or affordable specifically in developing countries because of limited resources at public sector, escalating costs of treatment and inadequate emphasis on primary prevention of oral diseases. Similar barriers also exist in utilisation of dental services among the Indian population. Integrating oral health into UHC will help improve oral health outcomes and reduce inequalities in access to care. To strengthen the oral health system towards UHC, public sector spending on oral health-care should be equally focused on primary care instead of directing mainly into only tertiary care, which could help reduce the number of complications progress to more expensive and more aggressive treatment.

Needs-led human resource planning for Sierra Leone in support of oral health

BACKGROUND

In Sierra Leone (SL), a low-income country in West Africa, dental care is very limited, largely private, and with services focused in the capital Freetown. There is no formal dental education. Ten dentists supported by a similar number of dental care professionals (DCPs) serve a population of over 7.5 million people. The objective of this research was to estimate needs-led requirements for dental care and human resources for oral health to inform capacity building, based on a national survey of oral health in SL.

METHODS

A dedicated operational research (OR) decision tool was constructed in Microsoft Excel to support this project. First, total treatment needs were estimated from our national epidemiological survey data for three key ages (6, 12 and 15 years), collected using the 'International Caries Classification and Management System (ICCMS)' tool. Second, oral health needs were extrapolated to whole population levels for each year-group, based on census demographic data. Third, full time equivalent (FTE) workforce capacity needs were estimated for mid-level providers in the form of Dental Therapists (DTs) and non-dental personnel based on current oral disease management approaches and clinical timings for treatment procedures. Fourth, informed by an expert panel, three oral disease management scenarios were explored for the national population: (1) Conventional care (CC): comprising oral health promotion (including prevention), restorations and tooth extraction; (2) Surgical and Preventive care (S5&6P and S6P): comprising oral health promotion (inc. prevention) and tooth extraction (D5 and D6 together, & at D6 level only); and (3) Prevention only (P): consisting of oral health promotion (inc. prevention). Fifth, the findings were extrapolated to the whole population based on demography, assuming similar levels of treatment need.

RESULTS

To meet the needs of a single year-group of childrens' needs, an average of 163 DTs (range: 133-188) would be required to deliver Conventional care (CC); 39 DTs (range: 30-45) to deliver basic Surgical and Preventive care (S6P); 54 DTs for more extended Surgical and Preventive care (S5&6P) (range 38-68); and 27 DTs (range: 25-32) to deliver Prevention only (P). When scaled up to the total population, an estimated 6,147 DTs (range: 5,565-6,870) would be required to deliver Conventional care (CC); 1,413 DTs (range: 1255-1438 DTs) to deliver basic Surgical and Preventive care (S6P); 2,000 DTs (range 1590-2236) for more extended Surgical and Preventive care (S5&6P) (range 1590-2236); and 1,028 DTs to deliver Prevention only (P) (range: 1016-1046). Furthermore, if oral health promotion activities, including individualised prevention, could be delivered by non-dental personnel, then the remaining surgical care could be delivered by 385 DTs (range: 251-488) for the S6P scenario which was deemed as the minimum basic baseline service involving extracting all teeth with extensive caries into dentine. More realistically, 972 DTs (range: 586-1179) would be needed for the S5&6P scenario in which all teeth with distinctive and extensive caries into dentine are extracted.

CONCLUSION

The study demonstrates the huge dental workforce needs required to deliver even minimal oral health care to the Sierra Leone population. The gap between the current workforce and the oral health needs of the population is stark and requires urgent action. The study also demonstrates the potential for contemporary epidemiological tools to predict dental treatment needs and inform workforce capacity building in a low-income country, exploring a range of solutions involving mid-level providers and non-dental personnel.

Medical-Dental Integration-Achieving Equity in Periodontal and General Healthcare in the Indian Scenario

Aims:

Dentistry and medicine have been treated as separate entities by healthcare professionals as well as the populace since a long time. Although dentistry as a standalone entity has achieved considerable progress, there is a significant inequity in the accessibility, affordability, and acceptability of dental care among various socioeconomic strata in the community. Moreover, it is becoming increasingly evident that oral diseases and systemic diseases often share multiple risk factors. Management of oral and systemic diseases as distinct units often results in duplication of care and wastage of resources. This paper gives information on the models of medical-dental integration and possible methods for integrating the same into Indian healthcare scenario.

Materials and Methods:

A literature search was performed in PubMed/MEDLINE, CINAHL, Web of Science, and Google Scholar for articles pertaining to medical-dental integration. The data obtained were collated.

Results:

Literatures show that different modalities for medical-dental integration are in practice. However, there is a paucity in conceptual models that may be applied to bring about such an integration into the Indian healthcare system.

Conclusion:

Integration of medical and dental care would pave the way for equity in health care for everyone. Conceptual models for integrating oral disease surveillance into systemic disease have been proposed in this paper.

Neighborhood Contexts and Oral Health Outcomes in a Pediatric Population: An Exploratory Study

Aims: This study aimed to explore the impacts of neighborhood-level socioeconomic contexts on the therapeutic and preventative dental quality outcome of children under 16 years. Materials and Methods: Anonymized billing data of 842 patients reporting to a university children’s dental over three years (March 2017–2020) met the inclusion criteria. Their access to care (OEV-CH-A), topical fluoride application (TFL-CH-A) and dental treatment burden (TRT-CH-A) were determined by dental quality alliance (DQA) criteria. The three oral health variables were aggregated at the neighborhood level and analyzed with Canadian census data. Their partial postal code (FSA) was chosen as a neighborhood spatial unit and maps were created to visualize neighborhood-level differences. Results: The individual-level regression models showed significant negative associations between OEV-CH-A (p = 0.027) and TFL-CH-A (p = 0.001) and the cost of dental care. While there was no significant association between neighborhood-level sociodemographic variables and OEV-CH-A, TRT-CH-A showed a significant negative association at the neighborhood level with median household income and significant positive association with percentage of non-official first language (English or French) speakers. Conclusion: Initial analysis suggests differences exist in dental outcomes according to neighborhood-level sociodemographic variables, even when access to dental care is similar.

Oral Health-Related Knowledge, Attitudes and Behaviours of Elementary School Teachers

BACKGROUND

elementary schoolteachers play a central role in shaping their students' beliefs, attitudes, and behaviours related to health and oral hygiene. This study was designed to evaluate Turkish schoolteachers' levels of oral health knowledge, attitudes, and behaviours.

METHODS

A cross-sectional survey-based study was conducted among elementary schoolteachers in Istanbul using a validated self-administered questionnaire. The questionnaire was composed of 36 multiple-choice items categorised into six sections, and the participants were recruited using convenience sampling. (3) Results: A total of 385 elementary schoolteachers participated in this study. The majority were female (62.2%), qualified with a licensure degree (81.3%) and working in public schools (86.5%). Female gender and greater work experience were found to be promoters for oral health knowledge and positive attitudes. The correlation between their perceived knowledge and actual knowledge was very weak, thus suggesting that the teachers are inclined to overestimate their knowledge.

CONCLUSIONS

The Turkish elementary schoolteachers showed satisfactory oral health knowledge and attitudes toward oral health education. The teachers' knowledge about dental trauma management was inadequate, necessitating urgent educational interventions, especially for physical education teachers, who are at the greatest risk of encountering such events during their work. The oral hygiene behaviours were not associated with teachers' oral health knowledge, attitudes, or practice, thus requiring further investigation.

Management of dental caries lesions in Latin American and Caribbean countries

Caries management at the lesion level is dependent on the lesion activity, the presence of a cavitation (either cleanable or non-cleanable), and lesion depth as evaluated via radiographic examination. A variety of non-invasive, micro-invasive, and minimally invasive treatment (with or without restoration) options are available for primary and permanent teeth. Non-invasive strategies include oral hygiene instructions, dietary counseling, and personal as well as professional use of fluoridated products that reduce demineralization and increase re-mineralization. Micro-invasive procedures include the use of occlusal resin sealants and resin infiltrants, while minimally invasive strategies comprise those related to selective removal of caries tissues and placement of restorations. Deep caries management includes indirect pulp capping, while exposed pulp may be treated using direct pulp capping and partial or complete pulpotomy. The aim of the present study was to review available evidence on recommended preventive and restorative strategies for caries lesions in Latin American/Caribbean countries, and subsequently develop evidence-based recommendations for treatment options that take into consideration material availability, emphasize ways to adapt available treatments to the local context, and suggest ways in which dentists and health systems can adopt these treatments.

Cost-effectiveness of caries preventive interventions - a systematic review

OBJECTIVE

The primary purpose of this study was to assess the cost-effectiveness of caries preventive interventions.

MATERIAL AND METHODS

A systematic review was conducted, following the PRISMA Statement. Four electronic databases were searched (final search 16 March 2020). Studies fulfilling the inclusion criteria were independently critically appraised, by two reviewers in parallel. Data from each included study were extracted and tabulated: the analysis used a narrative approach to present the results of the estimated cost-effectiveness.

RESULTS AND CONCLUSIONS

Twenty-six publications fulfilled the inclusion criteria and were of low or moderate risk of bias. Ten publications were economic evaluations, directly based on empirical studies, and the other 16 were modelling studies. Most of the studies concerned interventions for children and the most common were analyses of fluoride varnish and risk-based programs. Some of the studies showed both reduced cost and improved outcomes, but most studies reported that the improved outcome came with an additional cost. The results disclosed several cost-effectiveness evaluations of caries preventive interventions in the literature, but these target primarily children at high risk. There is a scarcity of studies specifically targeting adults and especially the elderly.

Taxes to Unhealthy Food and Beverages and Oral Health in Mexico: An Observational Study

In January 2014, taxes on sugar-sweetened beverages and nonessential energy-dense food were implemented in Mexico to discourage the consumption of these products. Published evaluations have shown reductions in purchases of taxed food and beverages associated with the implementation of this fiscal policy. Although there are some studies on the impact on health based on simulation studies, no evaluations with empirical data on changes in oral health have been published. We used administrative records and data from an epidemiological surveillance system to estimate changes in (1) outpatient visits related to dental caries; (2) having experienced dental caries: Decayed, Missing and Filled Teeth (DMFT) >0 for permanent dentition or dmft >0 for primary dentition (dmft); (3) number of teeth with caries experience (DMFT and dmft), (4) cases with DMFT >0 or dmft >0, and (5) the series of mean DMFT or dmft, associated with the taxes. We estimated probit and negative binomial models for outcomes at individual level, and interrupted time series analysis for population-level outcomes. The implementation of the taxes was associated with negative changes in the trends of outpatient visits, as well as for cases with DMFT >0, dmft >0 and mean DMFT. Taxes were also associated with a lower probability of having experienced dental caries and with a lower number of teeth with caries experience in the samples studied. Our results suggest positive impacts of the implementation of taxes on unhealthy food and beverages in the oral health of Mexicans, which are the first health benefits observed, and add to the health benefits predicted by modeling studies.

Single DNase or Proteinase Treatment Induces Change in Composition and Structural Integrity of Multispecies Oral Biofilms

Biofilm virulence is mainly based on its bacterial cell surrounding biofilm matrix, which contains a scaffold of exopolysaccharides, carbohydrates, proteins, lipids, and nucleic acids. Targeting these nucleid acids or proteins could enable an efficient biofilm control. Therefore, the study aimed to test the effect of deoxyribonuclease I (DNase I) and proteinase K on oral biofilms. Six-species biofilms (Streptococcus mutans, Streptococcus oralis, Actinomyces oris, Fusobacterium nucleatum, Veillonella dispar, and Candida albicans) were exposed to DNase I (0.001 mg/mL, 0.002 mg/mL) or proteinase K (0.05 mg/mL, 0.1 mg/mL) for 1 h during biofilm formation. After 64 h, biofilms were harvested, quantified by culture analysis and visualized by image analysis using CLSM (confocal laser scanning microscopy). Statistical analysis was performed by ANOVA, followed by the Tukey test at a 5% significance level. The biofilm treatment with proteinase K induced a significant increase of Logs₁₀ counts in S. mutans and a decrease in C. albicans, while biofilm thickness was reduced from 28.5 μm (control) to 9.07 μm (0.05 mg/mL) and 7.4 μm (0.1 mg/mL). Treatment with DNase I had no effect on the total bacterial growth within the biofilm. Targeting proteins of biofilms by proteinase K are promising adjunctive tool for biofilm control.

Oral health-seeking behavior among different population groups in Enugu Nigeria

Introduction

This study investigates the oral health-seeking behaviour of households and its influence on demand for dental caries treatment services in Enugu state Nigeria.

Methods

A quantitative descriptive cross-sectional study was used to explore the oral health seeking pattern of 378 urban and 348 rural household respondents in Enugu state Nigeria. The study explored dental caries treatment-seeking, oral health behavior of respondents using the three dynamics of the Andersen and Newman health utilization model; predisposing, enabling and need factors.

Findings

Recommendations from community members (48.9%), severity of disease (22.1%), and cost of treatment (19.4%) all influenced where oral healthcare was first sought. Gender and type of occupation, influenced positive oral health-seeking behavior (p<0.05). The least poor socioeconomic status (SES) group, sought dental treatment in the private dental clinics, while the very poor and most poor SES groups used traditional healers, home treatment and patent medicine dealers more. Dental fillings and extractions were generally the most accessed treatment options for dental caries. The tendency for all the SES groups (especially the least poor), to choose tooth extraction more as a treatment option for dental caries was influenced by the oral health awareness level of respondents and the cost of dental fillings. (p<0.05).

Conclusion

The findings suggest that interventions to create increased oral health awareness targeted at education on preventive strategies, appropriate time and place to seek oral health care and dental caries treatment, as well devising and implementing health financing options such as dental insurance would enable individuals to seek appropriate treatment for dental caries on time. In addition, it will reduce the proportion of people visiting unorthodox healthcare providers for their oral health problems or choosing cheaper but inappropriate treatment options.

The Effect of a Personalized Oral Health Education Program on Periodontal Health in an At-Risk Population: A Randomized Controlled Trial

While periodontal disease is associated with many risk factors, socioeconomically disadvantaged communities experience the highest disease burden. The aim of this study was to evaluate the effectiveness of a personalized oral health education program, in combination with routine dental treatment, in participants from a low socioeconomic community. We used a randomized, controlled, examiner-blinded clinical trial. A total of 579 participants (aged 18–60 years) were randomly grouped: the intervention group (n = 292) received a personalized oral health education program in combination with routine dental care and the control group (n = 287) received routine dental care. All participants were assessed for improvement in oral health care behaviors, dental plaque, and periodontal status at baseline, 12 months, and 24 months. We found a significant drop (p < 0.001) in the plaque indices, Periodontal Probing Depths (PPD) and Bleeding on Probing (BOP) between baseline and the 12-month follow-up for both groups. For BOP, the number of sites positive was significantly different between baseline and the 24-month follow-up (p = 0.037). No differences were found between the two groups for any evaluated clinical outcome. The personalized oral health education program used in the current study did not appear to add significant improvement to clinical outcomes of periodontal health compared with routine restorative dental care per se.

Education intervention with respect to the oral health knowledge, attitude, and behaviors of refugee families: A randomized clinical trial of effectiveness

Objectives

The study assessed the effectiveness of an oral health educational and behavioral intervention program in improving the knowledge, attitudes, and behaviors of refugee families.

Methods

This randomized 2‐arms, controlled, single site, clinical trial assessed the dental knowledge, attitudes, and behaviors related to oral health at baseline and three times over the course of the 6 months of the intervention in recent refugee families. Participating families were educated on five topics in oral health in two 1‐hour sessions utilizing existing oral health education materials adapted to be linguistically and culturally appropriate for demonstration and instruction. Culturally competent techniques and motivational interviewing styles were also implemented during sessions. Pre/post surveys were used to assess changes to knowledge, attitudes, and behavior among refugee family participants.

Results

Out of the 66 families enrolled in the program, 52 (72 percent) completed visits over the course of 6 months. Differences between the intervention and control groups were not significant between baseline and 3 to 6 months later (P > 0.05).

Conclusions

A short‐term, culturally informed oral health educational and behavioral intervention program did not improve oral health‐related knowledge, attitudes, or behaviors in a diverse group of recent refugee families.

Clinical and economic analysis of caries prevention programs by mathematic modeling

Relevance. Underestimating the importance of economic analysis is the barrier to the implementation of cariesprevention programs.

The aim is to study with use of mathematic modeling method the clinical and economic effectiveness of dental caries prevention programs provided for schoolchildren.

Materials and methods. The method of mathematic modeling was used to evaluate the clinical and economic efficiency of the caries prevention programs (educational, fissure sealing, fluoride varnish). The cost of prevention program implementation and the expenses for caries treatment without prevention were calculated according to the rate of Volgograd territorial mandatory medical insurance Fund for 2018 year. The differences between the caries prevention program’s cost and the expenses needed for the treatment of “prevented caries” were considered as saving.

Results. It was revealed that the Educational Dental Program for the first grade schoolchildren has short duration (2 years) of clinical-economic efficiency. The Continuous Educational Dental Program applied for 6 years by dental hygienists or dentists led to saving (per 100 children) of 99.5-115.0 or 84.0-99.6 thousand roubles respectively. The economic effect of The First Permanent Molar Fissure Sealing Program was revealed after 2 years only when The Program was implemented by dental hygienists. After 6 years of working with this Program the saving were 181.3 or 146.2 thousand roubles per 100 children depending on who implemented the Program, dental hygienists or dentists. The cost of Fluoride Varnish Program implementation was higher than the treatment of “prevented caries”. However, the number of “prevented caries” after fluoride varnish application is higher than after the implementation of the Educational Dental Programs. Moreover, fluoride varnish, in contrast to fissure sealing, prevents caries of smooth surfaces of permanent teeth.

 

Conclusions. The method of mathematic modeling can be used for the development of the caries prevention programs in various regions considering the availability of personnel and financial resources, and for evaluation of the clinical and economic effectiveness of preventive programs implementation.

A scoping review of cost-effectiveness analyses of school-based interventions for caries

OBJECTIVES

The aims of this study were to: identify the evidence on cost-effectiveness of school-based interventions for caries prevention globally up to 2019; summarize key characteristics of interventions applied within this setting; summarize the reporting quality of previous studies; and to identify and analyse knowledge gaps.

METHODS

A scoping review of published literature on the cost-effectiveness of school-based interventions to prevent child tooth decay was conducted. A search in Medline, Cinahl and Embase was performed with no date restriction. Reporting quality of the included studies was assessed against Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist.

RESULTS

Of the 738 records identified in the initial search, 15 studies met the pre-specified inclusion criteria. The majority were published after 2011 (n = 9,) and applied to high-income countries (n = 12). Nearly 80% of the studies assessed the cost-effectiveness of the interventions based on topical fluoride therapies and fissure sealants at school premises. Although, the outcome measures differed across the studies, almost all the caries preventive interventions were cost-saving or cost-effective when compared with usual care. Compliance with the CHEERS checklist differed.

CONCLUSIONS

There is evidence to suggest that school-based caries preventive interventions are cost-effective, and in some cases cost-saving. Further evidence is required from low- to middle-income countries to confirm the generalizability of these findings. Future studies should consider adopting Quality Adjusted Life Years as a generic outcome measure that would enable the cost-effectiveness findings to be compared across different types of interventions and diseases. Improved standardization and quality of reporting are also required.