Prioritization, Incentives, and Resource Use for Sustainable Dentistry: The EU PRUDENT Project

KNOWLEDGE TRANSFER STATEMENT

The EU PRUDENT project aims to enhance the financing of oral health systems through novel evidence and implementation of better financing solutions together with citizens, patients, providers, and policy makers. The multicountry nature of the project offers unique windows of opportunity for rapid learning and improving within and across various contexts. PRUDENT is anticipated to strengthen capacities for better oral care financing in the EU and worldwide.

O-Health-Edu: Advancing oral health: A vision for dental education

The prevalence and burden of untreated oral diseases throughout the life course remains high worldwide, and inequalities in oral health and dental care are increasing. This is a major public health issue that is not being enough addressed by the health care systems. To better manage populations' oral health, oral health professionals must be trained to adapt to population needs and societal and technological changes. Furthermore, dental institutions must fulfill their social responsibility by prioritizing educational and research activities that promote advancing individual and community health. In Europe, great variability exists between dental programs within the same country or between countries. This variability is an issue as European graduates can practice around the European Union through mutual recognition of their qualifications. This might lead to inequities in the availability, accessibility, acceptability and quality of health services. The convergence of competencies and quality standards at the international level must thus be better clearly identified, defined and improved. The purpose of the O-Health-Edu, EU funded project, “Advancing Oral Health: A vision for Dental Education” is thus to assess the current situation concerning the oral health professionals' education (OHP) and to identify educational priorities so that future graduating OHPs have competencies aligned with emerging population needs. The project is supported within the KA203 - “Cooperation for Innovation and the Exchange of Good Practices - Strategic Partnerships for higher education” Erasmus program. It began in October 2019 for three years, with eight European university partners and the ADEE (Association for Dental Education in Europe). The firsts steps consist of a scoping review to identify the available information followed by a questionnaire survey to gather more comprehensive data so that to build an opened data source, and a glossary of dental education terms.

Key messages

Few Information about the current situation of dental education in Europe. Graduates must be equipped with adequate competencies to face populations needs.

Gender Inequalities in the Dental Workforce: Global Perspectives

The aim of this review is to investigate the growth of diversity and inclusion in global academic dental research with a focus on gender equality. A diverse range of research methodologies were used to conduct this review, including an extensive review of the literature, engagement of key informants in dental academic leadership positions around the world, and review of current data from a variety of national and international organizations. Results provide evidence of gender inequalities that currently persist in dental academics and research. Although the gender gap among graduating dental students in North America and the two most populous countries in Europe (the United Kingdom and France) has been narrowed, women make up 30% to 40% of registered dentists in countries throughout Europe, Oceania, Asia, and Africa. In academic dentistry around the globe, greater gender inequality was found to correlate with higher ranking academic and leadership positions in the United States, United Kingdom, several countries in European Union, Japan, and Saudi Arabia. Further disparities are noted in the dental research sector, where women make up 33% of dental researchers in the European Union, 35% in North America, 55% in Brazil, and 25% in Japan. Family and societal pressures, limited access to research funding, and lack of mentoring and leadership training opportunities are reported as also contributing to gender inequalities. To continue advancing gender equality in dental academia and research, efforts should be geared toward the collection and public dissemination of data on gender-specific distributions. Such evidence-driven information will guide the selection of future strategies and best practices for promoting gender equity in the dental workforce, which provides a major pipeline of researchers and scholars for the dental profession.

[Status of health and oral health of the elderly population in Lebanon]

Lebanon is in demographic transition as more people reach increasingly older age; 10% of the population in Lebanon is elderly. The incidence of chronic diseases and oral diseases increases significantly with age. However, 55% of the elderly have no health insurance and 82% have no dental insurance. Both noncommunicable diseases (NCDs) and oral diseases are a major health burden in the country and share the same risk factors. The WHO strategy for prevention and control of noncommunicable diseases should therefore be a new approach for the prevention and control of dental diseases among Lebanese elderly. This paper aims to increase the awareness of the medical community in Lebanon about the interrelationship between general and oral health in the elderly and concludes with the need for the Ministry of Health to develop policies and national action plans against NCDs to reduce not only mortality from NCDs but also morbidity from oral diseases.

Periodontal disease and stroke: a meta-analysis of cohort studies

This review aimed to determine the association between periodontal disease and stroke incidence by a meta-analysis of cohort studies. Cohort studies that evaluated the incidence of stroke (fatal or non-fatal, ischaemic or haemorrhagic) and baseline periodontal status and calculated relative risk values were included. The quality of the included studies was assessed using an evaluation grid. The analyses were conducted separately for three outcomes: periodontitis, gingivitis and loss of teeth. Adjusted values of relative risk or of hazard ratio were used to assess risk values in each study. Random effects meta-analyses were conducted when data could be pooled. From the 743 references retrieved, only nine cohort studies were suitable for inclusion in this review. Quality scores of the studies varied greatly. Three prospective studies, which used reliable indicators of periodontal disease, obtained the highest scores. Conversely, three studies that used a subjective evaluation of stroke incidence or diagnosed stroke without imaging obtained the lowest score. The results of the meta-analyses varied depending on the outcome considered and the type of stroke. The risk of stroke was significantly increased by the presence of periodontitis [relative risk 1.63 (1.25, 2.00)]. Tooth loss was also a risk factor for stroke [relative risk 1.39 (1.13, 1.65)]. The risk of stroke did not vary significantly with the presence of gingivitis. This review shows that periodontitis and tooth loss are associated with the occurrence of stroke.

Using e-learning to train dentists in the development of standardised oral health promotion interventions for persons with disability

BACKGROUND

This study aims to evaluate whether an e-learning curriculum was sufficient to impart the necessary knowledge to dentists to allow them to implement an oral health promotion intervention in an institution for persons with disability.

MATERIALS AND METHODS

Participants were asked to complete a 10-module online training course and to implement a standardised intervention in an institution. The outcome measures were as follows: online tracking of progress; multiple choice questionnaires completed at the end of most modules; self-efficacy questionnaire completed before and after online training; completion of training and calibration in the use of a standardised risk assessment form; initiation and full completion of an oral health promotion intervention in an institution; satisfaction of participants with the online training experience; and evaluation of the impact of the intervention by the institution staff.

RESULTS

The study sample included 26 dentists. The 10 modules were passed by 24 dentists, and the mean value of the highest overall score recorded in the multiple questionnaires was 88.4% (± 4.0). Twenty participants completed the self-efficacy questionnaire before and after training; the mean values of scores after training were statistically different and higher than those at baseline. Questionnaire regarding satisfaction with the online training experience was completed by 22 participants; all of them stated that they were satisfied with the online training experience.

CONCLUSIONS

The results indicate that the online training course helped participants to increase self-efficacy and to provide interventions in institutions. This study could have implications for both undergraduate and postgraduate dental education in France.

Caries prevalence and fluoride use in low SES children in Clermont-Ferrand (France)

OBJECTIVE

To evaluate the association between dental caries experience and preventive behaviours of children residing in a deprived area in Clermont-Ferrand (France).

PARTICIPANTS AND METHODS

All 4-5 yr-olds attending nine schools in deprived areas of the city were invited to participate and 81% (n=282) consented and were examined. Dental caries was recorded at the dentine threshold. Parents completed a questionnaire concerning family demographics and the child's use of fluoride. Non-parametric tests and logistic regression assessed the relative importance of SES and fluoride variables on dental status (dt>1).

RESULTS

Fifty four (19%) of the examined children were living in families with an immigrant background, 33% were fully covered by the national health insurance programme for deprived families. Caries experience was high; mean dft was 1.94 (3.31) and 30% of the children had >1 carious teeth. Thirty percent of the families reported using fluoridated salt. Tooth brushing once daily was reported for 39% and twice daily for 26%. Parents declared supervising tooth brushing for 60%. Two thirds of the children, according to their parents, used fluoride supplement between birth and two years. Supervised tooth brushing was significantly correlated with lower mean dt scores. Systemic fluoride use was poorly related to dental caries Immigrant background, family size, type of health insurance and mother's unemployment were significantly correlated with caries prevalence. In multivariate analysis, immigrant status, supervised tooth brushing and parental knowledge about fluoride in toothpastes were significant caries predictors.

CONCLUSIONS

The majority of low SES children did not practice effective caries prevention; few reported twice daily brushing with fluoride toothpaste. Caries experience was very high and much was untreated. Immigrant status, supervised tooth brushing and parental knowledge about fluoride in toothpastes were significant caries predictors.

Caractéristiques des patients ayant recours à l'unité d'urgence odontologique du CHU de Clermont-Ferrand (France)

BACKGROUND

Data on the profile of patients attending hospital dental emergencies units in France, and the activity of these units is scarce. Such knowledge is nevertheless necessary not only to optimize care, but also as the first step in a quality assurance process.

METHODS

A cross-sectional study was conducted in the Clermont-Ferrand University Hospital dental emergencies unit to estimate its activity and ascertain the profile of the attending patients. The unit's computerized database was used to list the time distribution of the consultations as well as the profile of the patients attending in 2003 (N=2207). Furthermore, patients attending in February and March 2003 (N=383) completed a questionnaire about why they consulted and their regular dental follow-up. The emergency diagnoses as well as the treatment applied were also noted.

RESULTS

The general profile of patients who attended the unit in 2003 was as follows: age of most patients 20-29 years, 52% of the patients were male, majority (85.4%) lived in Clermont-Ferrand or its suburbs, 13.5% had subsidized health insurance for disadvantaged people and 43% consulted the unit only when they suffered from a dental emergency. There were more consultations in the afternoons (59.2%) and their number decreased gradually during the week. The results from the questionnaire indicated that: pain (42%) and prosthetic problems (34%) were the most frequent reasons for consulting, 38.8% of the patients waited more than 7 days before attending and 50.8% had not seen a dentist in the previous year except in case of emergency.

CONCLUSION

The patients attending the hospital units for dental emergencies have a special profile. These units should adapt care to the needs of attending patients who generally do not consult regular dental care facilities.

Impact of new prostheses on the oral health related quality of life of edentulous patients

OBJECTIVE

A study was conducted to evaluate the impact of the placement of complete dentures by using the Global Oral Health Assessment Index (GOHAI).

BACKGROUND

Oral health quality of life indicators can be used to evaluate the effects of dental treatments.

MATERIAL AND METHODS

The 26 participants were treated in a French University Clinic during 2002. They were randomly divided into two groups. Each group received new prostheses, but evaluation of the quality of life was made at different periods [baseline, denture placement (group 1), 6 and 12 weeks (group 2) after placement]. A questionnaire was used to collect information on patient's satisfaction with the previous and new prostheses. Nonparametric tests were used to test the relationships between patients' satisfaction or baseline data and GOHAI variations with time as well as to compare mean values of GOHAI within each group.

RESULTS

At baseline, the impact of oral health problems was apparent; the mean GOHAI-Add score was 45.8 (10.2). Six weeks after placement of the new denture, there was no difference in GOHAI scores compared with the initial assessment. An improvement in GOHAI score was observed 12 weeks after the participants received their new dentures (p < 0.05). Change in GOHAI-Add scores was negatively correlated with the initial GOHAI-Add score. Patients who preferred the new prosthesis enjoyed a positive change in GOHAI scores (p < 0.001). There was a relationship between participants' satisfaction with the new dentures and change in GOHAI scores (p < 0.05).

CONCLUSION

The GOHAI can be used to evaluate needs for and effect of the making of new complete dentures.

Validation of an oral health quality of life index (GOHAI) in France

Oral health has traditionally been defined in terms of disease. Today, health is seen in a wider context: taking into account its impact on everyday living. Several indices attempt to capture this dimension. The Geriatric Oral Health Assessment Index (GOHAI) has been adapted for general use and tested on adult samples, mainly in North America. Language, cultural norms and the health care system in France are different and this raises the need to validate the GOHAI in France before it receives widespread use.

OBJECTIVES

The purpose of this study was to test the validity of a French version of the GOHAI.

METHODS

The GOHAI is based on responses to a 12-item self-administered questionnaire. The items were translated into French, back-translated and compared with the original. After pilot testing and minor modifications, the French version was administered to a group of low-income persons benefiting from the national health insurance system (n = 260, 18-45 years). Measures for stability and internal consistency were calculated. Concurrent and discriminant validity were assessed.

RESULTS

Cronbach's alpha (0.86) showed a high internal consistency and homogeneity between items. Item-scale correlations varied between 0.40 and 0.78. Repeat administration of the GOHAI to 32 participants gave weighted kappa coefficients from 0.51 to 0.87 and a Pearson's correlation coefficient of 0.87. Low GOHAI scores were associated with perceptions of poor oral and general health, low satisfaction with oral health and a perceived need for dental care. There were significant relationships between the GOHAI score and most objective measures of dental status except FT. Younger, well-educated and higher income respondents were more likely to have a high GOHAI score.

CONCLUSION

The French version of the GOHAI exhibits satisfactory psychometric properties but two items (one about swallowing, the other with complex sentence structure) had poor stability.

Rugby players' satisfaction with custom-fitted mouthguards made with different materials

OBJECTIVES

This study compared the comfort of two bimaxillary custom-fitted mouthguards. One type was made with silicone rubber and the other with methyl-methacrylate (acrylic).

METHODS

The study was a within-subject crossover clinical trial with 52 high-school rugby players who were randomly allocated to one of two groups. The first group wore a silicone mouthguard for 4 months and an acrylic one for the following 4-month period. The second group wore an acrylic mouthguard followed by a silicone one for similar periods. Comfort, bulkiness, stability, hardness, ability to talk and to breathe, oral dryness, nausea and inclination to chew were evaluated for each period using a Visual Analogue Scale questionnaire.

RESULTS

There was no significant difference concerning comfort, bulkiness, ability to talk and to breathe, oral dryness and nausea between silicone and acrylic mouthguards by group and time of examination (Three-way ANOVA P>0.05). Acrylic mouthguards were more stable and harder than silicone ones (Wilcoxon's test P<0.01). Tendency to chew was greater for silicone appliances (P<0.01). For stability, hardness and inclination to chew, there was no significant difference in the response of the players based on the sequence of use of the two types of mouthguard during the survey (Mann-Whitney test P>0.05). At the end of the study, 56% of the players preferred to keep the acrylic mouthguard and 44% chose the silicone one. This choice did not vary between the groups (chi2, P>0.05).

CONCLUSION

Silicone rubber mouthguards were well accepted by the players but technical improvements in silicone materials are needed to improve hardness and stability of silicone mouthguards for sport.

Evaluation of a dental benefit plan for children conducted in Auvergne, France, since 1992

Usually, the French dental insurance system covers the cost of restorative treatment but does not reimburse the cost of preventive therapies. A French sick-fund covering self-employed persons tested a new dental benefit plan for children intended to provide an incentive to develop office-based preventive activities. The programme, which started in 1992, concerns all 4-year-old children of self-employed workers in a single French region (Auvergne). Participants undergo an annual examination by the dentist of their choice until their 15th birthday. If the child is seen every year, all services related to dental caries (preventive and restorative) are provided free of charge. An ongoing evaluation of the programme was necessary to determine its influence on the development of office-based preventive activities and the dental health of the participants. A cohort of children enrolled in the programme in 1992 was followed over 4 years to examine the patterns of service use. In addition, a cross-sectional study comparing the caries experience of all 8-year-old children participating continuously in the programme (test sample) with that of a sample of control children (n=90) was conducted in 1996. Data from the longitudinal follow-up indicate that 43.37% of the 551 children to whom the programme was offered in 1992 underwent an annual examination in the first year. Of the children enrolled in 1992, 55.2% were still participating in the programme in 1996. Results showed that independent practitioners continued to focus on restorative treatment rather than preventive therapy. Results from the cross-sectional study are in accordance with this trend. The number of caries-free children was identical in test and control samples and the mean dft, DMFT, DT and dt did not vary between the two groups (Student's t-test, P>0.05). However the mean number of filled teeth was significantly higher in the test children than in the controls (P<0.01). For children with caries, the mean dft was 23.5% greater in the test group than in the control group (P<0.05). In Auvergne, a large number of families were not ready to participate in a plan that required them to take their child to the dentist every year. There was not a perceived need for regular preventive dental care, an attitude probably reinforced by the interventionist approach undertaken by the dentists over the survey period. Moreover, the plan did not provide an incentive for dentists to develop office-based preventive activities.

Factors affecting caries experience in French adolescents

Three hundred French 14-15-yr-old adolescents were randomly selected. They were examined clinically and caries experience was determined by using the DMFS index. The aim of this investigation was to evaluate children's habits using a self-administered questionnaire, to clarify the actual influence of well-known factors such as fluoride exposure, diet, oral hygiene and socioeconomic factors on caries experience and to stress those factors of primary importance. A multiple regression analysis revealed the variables which significantly contributed to explain DMFS scores in a final model: Age, sex, frequency of sweet consumption, use of standard or high fluoride toothpastes, bleeding during toothbrushing, living in St Yorre (F- = 0.45 mg/l). At a time when caries experience is decreasing, it seems that fluoride supply, snacking and oral hygiene are still independent and significant determinants of caries experience in French adolescents.

Changes in oral health conditions among 6- to 15-year-old children in Auvergne (France) 1987-1991

A representative sample of 1,200 schoolchildren of Auvergne (France) ranging in age from 6 to 15 years was randomly selected. Dental caries experience was determined using the dft, DMFT and DMFS indices. The plaque index and the gingival index were also recorded. Comparison with an identical 1987 study enabled the changes in schoolchildren's dental health to be examined. Significant reductions were observed in all age groups for the DMFT and DMFS indices and in the 6-9-year-old group for the dft index. The mean DMFT score for 12-year-old children was 1.97 in 1991, as compared to the score of 4.62 reported in 1987 (57.3 per cent reduction). While no significant variation was observed in the gingival index, the plaque index decreased significantly for the 7-14-year-old group. The comparison confirmed the trend to a lower caries experience in schoolchildren in Auvergne as in many Western European countries.