O-HEALTH-EDU: A viewpoint into the current state of Oral Health Professional education in Europe: Part 1: Programme-level data

INTRODUCTION

Current legislation leaves Oral Health Professional (OHP) education open to wide interpretation and may result in significant variation in educational practice and resultant professional attributes across Europe. Data regarding the current state of OHP education across Europe is limited. The aim of Part 1 of this series is to provide programme-level data for Primary Dental Degree Programmes, Dental Hygiene and Postgraduate Education.

METHODS

A 91-item questionnaire was developed following the Delphi method. The questionnaire and the Articulate glossary of OHP education terms were developed concurrently to facilitate a common understanding of language. Piloting was performed in multiple stages and included institutions internal and external to the research group. The questionnaire was uploaded online and converted to a data hub, allowing dental schools to control their own data and update the data provided whenever they wish. All ADEE member schools (n = 144) were invited to provide data. Forty questions relating to school details, Primary Dental Degree Programmes, Dental Hygiene and Postgraduate Education were included in this part of the series.

RESULTS

Seventy-one institutions from 25 European countries provided data between June 2021 and April 2023, which represents a response rate of 49.3% of ADEE members. Programme-level data for Primary Dental Degree Programmes, Dental Hygiene and Postgraduate Education is presented including programme length, funding, languages and fees, student numbers and demographics, student admission and selection processes and permission to practice after graduation.

CONCLUSION

This series of papers, as far as the authors are aware, are the first attempts to build a comprehensive picture of the current state of OHP education in Europe. A comprehensive view of the state of OHP education in Europe is not yet available but the O-Health-Edu data hub provides a means for all education providers in Europe to contribute data to reach this goal. It is anticipated that the data hub will be updated and built upon over time to continually establish a clearer picture of the state of OHP education in Europe.

O-Health-Edu: A viewpoint into the current state of oral health professional education in Europe: Part 2: Curriculum structure, facilities, staffing and quality assurance

INTRODUCTION

Oral health professional (OHP) education is likely to vary across Europe in accordance with an EU directive that is open to broad interpretation. It is not clear how OHP curricula are structured or delivered across Europe. The objectives of Part 2 of this paper series are: (i) to provide an overview of common practices in curriculum structure, the availability of facilities, staffing (faculty) and quality assurance processes and (ii) to consider how the existing programme structures align to stakeholder guidance documents.

METHODS

A total of 27 questions from a 91-item questionnaire were used for this manuscript. The questionnaire was developed following the Delphi method to establish consensus from a group of experts. Members of the research team and colleagues from other countries in Europe completed a multi-step piloting process. An online data hub was created to allow the respondents to be data controllers and respond to the questionnaire. ADEE member schools (n = 144) were invited to provide data.

RESULTS

Totally, 71 institutions from 25 European countries provided data between June 2021 and April 2023, which represents a response rate of 49.3% of ADEE members. Data on curriculum approaches, teaching methods, integration of topics of interest, clinical education, staff-student ratios, access to facilities and new technologies, teaching staff (faculty) and quality assurance processes are presented for Primary Dental Degree Programmes.

CONCLUSION

To the best of our knowledge, this series of papers are the first attempts to provide a comprehensive overview of OHP education in Europe. Results showed that the majority of European dental programmes are engaged in providing innovative and scientifically grounded education in order to develop quality future OHPs. Nevertheless, significant variability in the delivery of clinical education across the European OHP schools was notable in this dataset. A comprehensive view of the state of OHP education in Europe is not yet available but the O-Health-Edu data hub provides a means for all education providers in Europe to contribute data to reach this goal. It is anticipated that the data hub will be updated and built upon over time to continually establish a clearer picture of the state of OHP education in Europe.

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.

Influence of an oral health promotion program on the evolution of dental status in New Caledonia: A focus on health inequities

New Caledonia is a sui generis collectivity of overseas France situated in the south Pacific Ocean. Geographical and social inequalities are superimposed on ethnic disparities with high prevalence of chronic diseases such as oral diseases. In 2012, the health agency has evaluated the children's health status. Then, an oral health promotion program was developed in 2014. Another study was conducted in 2019 in New Caledonia to appreciate the evolution of children's oral health. A sample of 488 9-years-old children was randomly selected. Dental status was clinically recorded, families and children answered questionnaires about oral health determinants. The methodology (sampling, study variables…) was similar to the one used in the 2012 study. Multivariate mixed-models were conducted to compare 2012 and 2019 dental status and to explore the determinants of caries experience in 2019. Results indicated that caries prevalence and experience decreased between 2012 and 2019, with nonetheless various trends depending on the province or type of indexes. The number of carious lesions (d3t + D3T) in 2019 was used as an outcome variable in four models. Model 1 integrated social variables; ethnicity was found to be the only significant determinant. Model 2 was related to oral health care; participation in the program & and access to oral health care was found to be significant. For oral health behaviours (model 3), tooth brushing frequency and consumption of sugary snacks were significant risk factors. In a final model with significant variables from the previous models, ethnicity, accessibility of oral health care, number of sealed molars, consumption of sugary snacks remained explanatory factors. Five years after the implementation of the oral health promotion program, positive changes in oral health have been observed. However, health equity is still an issue with varying health status depending on ethnicity, behavioural factors and accessibility to oral health care.

O-Health-Edu: A vision for oral health professional education in Europe

This consensus paper reports on the process of developing a renewed vision for Oral Health Professional (OHP) education across Europe, and forms part of a larger EU-funded collaborative Erasmus+ project, "O-Health-Edu." The vision aligns with the World Health Organisation milestones (2016) and resolutions (2021), and EU4Health programme (2020) objectives - and projects 20 years into the future, to 2040. This longitudinal vision takes a multi-stakeholder perspective to deliver OHP education that acts in the best interests of both students and patients, and sits within the context of a wider strategy for general health. Included, it is an infographic to help communicate the vision to various stakeholders of OHP education.

ARTICULATE: A European glossary of terms used in oral health professional education

INTRODUCTION

The Erasmus+O-Health-EDU project aims to gain a comprehensive view of oral health professional (OHP) education in Europe, through the development of web-based surveys and online toolkits. A glossary to facilitate a common language through which academic teams could cooperate and communicate more accurately was identified as a key need within the project. The aim of ARTICULATE was thus to create a shared language, with a European focus, for terms and concepts used in the field of OHP education.

METHODS

The methodology was developed from those published for construction of other glossaries with a circular and iterative process: the creation of content and definitions by a group of experts in OHP education, the testing of "fitness for purpose" of the content, and stakeholder consultation. All creation steps were followed by refinements based on testing results and stakeholder comments. The final glossary was then launched as an online resource including a built-in mechanism for user feedback.

RESULTS

The scope and structure of the glossary were mapped out at a workshop with 12 dental education experts from 7 European countries. A total of 328 terms were identified, of which 171 were finally included in ARTICULATE. After piloting with a close group of other colleagues, the glossary was opened for external input. Thirty European Deans or Heads of Education assessed the definition of each term as "clear" or "not clear." A total of 86 definitions were described as "clear" by all individuals. Terms deemed unclear by at least one individual were revisited and changes made to 37 of the definitions. In conjunction with the launch of the glossary, a range of stakeholder organisations were informed and asked to participate in an open global consultation by providing feedback online. Since its launch in June 2021, the ARTICULATE website (https://o-health-edu.org/articulate) has had an average of 500 visits/month. To promote community ownership, forms embedded on the ARTICULATE webpage allow users to give feedback and suggest new terms. A standing taskforce will meet regularly to consider amendments and make changes to ensure that the glossary remains a relevant and up-to-date resource over time.

CONCLUSION

ARTICULATE is a unique, evolving, online glossary of terms relating to OHP education, created as a resource for all interested OHP educators. The glossary is a key output of the O-Health-Edu project, which relies on a comprehensive vision of OHP education to address the future oral health needs of the European population.

Translation and preliminary validation of a French version of an ageism scale for dental students

BACKGROUND AND AIM

The World Health Organization considers ageism an important barrier to age-appropriate care for older adults. A new ageism scale for dental students (ASDS) has been validated in the United States, Brazil, Greece and Romania. The aim of this study was to validate a French version (ASDS-Fr).

METHOD AND MATERIALS

The 27-item ageism scale was translated from English into French, and its content validity was investigated using the content validity index. The translated version was completed by 180 dental students in the Dental School of Clermont-Ferrand in France. Principal component analysis (PCA) was performed and internal consistency reliability was calculated.

RESULTS

The final PCA model resulted in 10 items and three components that together accounted for 57.2% of the overall variance. The first component contained four items that point to a negative view of older adults; the second contained three items that appeared to reflect an absolving of responsibility for providing care to older adults; and the third contained three items that deal with gerodontology education.

CONCLUSIONS

This preliminary validation of the ASDS-Fr produced a new 10-item scale with three components with acceptable validity and reliability.

O-HEALTH-EDU: A scoping review on the reporting of oral health professional education in Europe

INTRODUCTION

The variability in oral health professional education is likely to impact on the management of oral health needs across Europe. This scoping review forms the initial part of a larger EU-funded collaborative Erasmus + project, 'O-Health-Edu'. The aim of this scoping review is to investigate how oral health professional education in Europe is reported.

METHODS

The PRISMA and Arksey & O'Malley methodological frameworks for scoping reviews were used to guide reviewers in answering the research question "How is oral health professional education reported in Europe?". The search strategy encompassed published literature searches, internet searches and further searching of relevant documents from educational organisations, regulators and professional bodies. Once the search strategy was developed, it was sent to key stakeholders for consultation. Sources were reviewed by two authors (JD, JF) and included in the review if they reported on oral health professional education in Europe.

RESULTS

A total of 508 sources were retrieved from all of the searches. A total of 405 sources were excluded as they did not report on the topic of interest, leaving 103 sources that reported on oral health professional education in Europe. Handsearching the references of published sources lead to a further 41 sources being screened, of which, 15 were included. In total, 33 duplications were removed and the final number of included sources was 85. The average year of publication for the included sources was 2007, with sources most commonly published in journals dedicated to dental education. Surveys represented the most common form of reporting. From the data obtained, four broad themes of reporting were evident: dental education at a programme level, dental education at a discipline level, other oral health professional education, and postgraduate education and continuous professional development.

CONCLUSION

The reporting of dental and oral health professional education in Europe is limited. Whilst there are many useful documents that provide guidelines on dental education, there is limited knowledge on how education is implemented and delivered. There is a greater need for comprehensive educationally driven programme-level data on oral health professional education across Europe.

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.

Social inequalities in oral health in a group of older people in a Middle Eastern country: a cross-sectional survey

BACKGROUND AND OBJECTIVE

The percentage of Lebanese older people has increased considerably. Given that Lebanese seniors are marginalized in the health policy-making process, we suggest a high social inequality in oral health that has not been studied so far. The purpose of our study was to describe and compare oral health status in a group of Lebanese older people according to their socioeconomic status (SES) MATERIALS AND METHODS: Participants were recruited from three different primary health care clinics in Beirut, Lebanon. Data were collected from an administered questionnaire that included sociodemographic variables, perception of oral health, and regular dental visits. Oral examination included the number of missing and decayed teeth, the prosthetic status, and the number of functional dental units (FUs). The SES of the participants was determined by educational level, previous or actual work, and neighborhood level.

RESULTS

264 participants aged 71.4 ± 6.27 years (64.7% female) were included in the study. Regular dental visit, dental status, FU, and oral health perception were significantly related to the participants' place of residence, educational level, and work. Moreover, the mean number of missing teeth (p = 0.048) and decayed teeth (p = 0.018) was significantly elevated in the low SES.

CONCLUSION

There is a clear socioeconomic inequality in oral health among the Lebanese older people. Further researches should explore the potential contribution of psychosocial and behavioral factors in explaining these disparities.

[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.

The pertinence of oral health indicators in nutritional studies in the elderly

BACKGROUND AND AIM

Studies concerning the more appropriate criteria for evaluating oral health in relation to nutrition in the elderly vary greatly. There is a need to identify the most relevant criteria for classifying dental indicators of mastication in nutritional studies, so these indicators may be considered for epidemiological and clinical purposes. The aim of this study was to explore the associations between nutritional deficit and measures of oral health in a group of elderly.

METHODS

A convenience sample of independent elderly aged 65 years or more attending two primary care clinics in Beirut, Lebanon was selected. Data were collected from a questionnaire including the Mini-Nutritional Assessment (MNA), Geriatric Oral Health Assessment Index (GOHAI) and questions about perception of xerostomia and chewing problems. The oral examinations recorded decayed, missing and filled teeth (DMFT), the prosthetic status and the number of functional units (FU).

RESULTS

The sample was composed of 121 women (mean age: 71.59 ± 5.97 years) and 80 men (mean age: 72.74 ± 6.98 years). They were allocated to two groups: 85 participants suffering from malnutrition (MNA score < 17, n = 17) or at risk of malnutrition (17 < MNA score < 24, n = 68) and 116 participants with a normal nutritional status (MNA score ≥ 24). Parameters that explain MNA variations were perception of xerostomia (OR = 3.49, 95% CI [1.66-7.34]), number of FU (OR = 2.79, 95% CI [1.49; 5.22]), and GOHAI score (OR = 2.905, 95% CI [1.40; 6.00]).

CONCLUSION

Further studies exploring factors affecting nutrition in the elderly should take into consideration perception of xerostomia, number of FUs and GOHAI score.

Comparison of the OHIP-14 and GOHAI as measures of oral health among elderly in Lebanon

BACKGROUND

The respective abilities of the GOHAI and OHIP-14 to discriminate between aged patients with different levels of oral diseases have rarely been studied in developing countries. The aim of this study was to compare the discriminative abilities of the OHIP-14 and the GOHAI in an elderly Lebanese population, and particularly to identify persons with different masticatory function.

METHODS

A sample of elderly, aged 65 years or more, living independently was recruited in two primary care offices in Beirut, Lebanon. Data were collected by means of personal interview and clinical examination. The Arabic OHIP-14 and GOHAI questionnaires were used after cultural adaptation for use in Lebanon. The internal consistency, reproducibility and concurrent validity were verified. To test their discriminative abilities, the ADD (GOHAI and OHIP) and SC (GOHAI and OHIP) scores were dichotomized according to the 25th and 75th percentile respectively and logistic regressions were conducted using socio-demographic, clinical and subjective explanatory variables.

RESULTS

Two hundred and six participants were included; mean age was 72 years and 60% were women. Good psychometric properties were observed for both questionnaires for internal consistency (Cronbach's alpha>0.88), reproducibility (ICC>0.86) and concurrent validity. Strong correlations were found between GOHAI and OHIP-14 scores but a high prevalence of subjects with no impact was observed using the OHIP-14. Both questionnaires were able to discriminate between participants according to age, perception of temporomandibular joint (TMJ) pain or functional status as represented by the number of dental Functional Units (FU). GOHAI was more discriminant since it identified participants with high dental care needs: high numbers of decayed teeth, low numbers of teeth and socially deprived status.

CONCLUSIONS

Lebanese elderly with high dental care needs and impaired oral health were identified more easily with the GOHAI. These results may guide the choice of dental indicators to use in a national geriatric survey.

Addressing children's oral health inequalities: caries experience before and after the implementation of an oral health promotion program

OBJECTIVE

(1) To evaluate the dental status of 5-year-old children in Clermont-Ferrand (France) in 2009; (2) To measure changes in children's dental status between 2003 and 2009; and (3) To estimate the impact of an Oral Health Promotion (OHP) program implemented in nine schools since 2005.

MATERIALS AND METHODS

All 5-year-olds attending public schools in deprived areas (n = 15) and six randomly selected other schools in Clermont-Ferrand were invited to participate. Dental status was recorded using d(3)mft, as in 2003. Parents responded to questions about their child's oral hygiene and provided socio-demographic information.

RESULTS

Of children invited, 478 (77%) were examined. Mean dmft was 1.18 (SD 2.61); 27.6% had at least one tooth affected. Caries experience varied significantly with deprivation status, oral hygiene and household SES indicators. The only difference observed between 2003 and 2009 was an increase in the 'f' component (p < 0.001). Dental status had slightly deteriorated in areas characterized in 2003 by low caries levels (p=0.07). In deprived areas, mean dmft increased in schools without the OHP program (p = 0.04). Changes between 2003 and 2009 were studied at school level using Multiple Factorial Analysis; it tended to improve in four schools, which had the OHP program. Household indicators of SES changed little. Oral hygiene levels varied differently from one school to another.

CONCLUSIONS

Caries experience was high, with large inequalities between children. No major differences were observed between 2003 and 2009. The OHP program has done little to reduce disparities in oral health, even if dental status improved in four schools.

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.

Dental status and measures of deprivation in Clermont-Ferrand, France

BACKGROUND

Many background variables, such as socioeconomic status (SES), may be measured at the level of the individual or using some ecological indicators.

OBJECTIVES

This study aimed to examine, in 5- and 10-year-olds in Clermont-Ferrand, the relationship between household SES indicators, SES measured as an area-based ecological variable and dental status.

METHODS

All 5- and 10-year-olds attending public schools in deprived and semi-deprived zones (n = 15) and six other randomly selected schools in Clermont-Ferrand were invited to participate. All children were examined clinically. On a questionnaire, parents provided sociodemographic information.

RESULTS

Of the children invited, 84% (880 children) were examined. Mean dft of 5-year-olds was 0.93 (SD 2.27); 26.5% had at least one tooth affected. The caries experience (DMFT) of 10-year-olds was 0.85 (SD 1.14) and 37.2% had permanent tooth caries experience. Caries experience varied significantly with school deprivation status: the greater the deprivation score, the more likely was poor dental health. Country of birth, parents' employment status, family size and health insurance type were significantly related to dental status. Logistic analyses estimated the importance of SES and ecological variables; deprivation influenced dental status in 5-year-olds even when household SES indicators were considered. In 10-year-olds, caries experience was influenced by household SES, immigrant background, father's employment and family size.

CONCLUSION

The use of school deprivation as an ecological measure status was useful for identifying population subgroups with different levels of oral health, particularly in young children. This indicator of social deprivation could be used for targeting preventive programmes to high caries risk communities defined geographically.

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.