Awareness and Incorporation of the Dental Home Concept Among General Dentists and Dental Therapists in Malaysia

Background The dental home concept (DHC) refers to an approach in oral healthcare that emphasizes establishing a long-term, comprehensive, and family-centered relationship between a patient and their primary dental care. This study determined the awareness and incorporation of the DHC among general dentists and dental therapists in Malaysia. Methodology A total of 154 general dentists and 137 dental therapists providing oral healthcare services at the Ministry of Health (MOH) primary care facilities throughout Malaysia participated in this cross-sectional study. A self-administered questionnaire was used to measure the respondents' awareness of the DHC and incorporation of the DHC characteristics into their practice. Results Most dentists and dental therapists (61.7% and 67.2%, respectively) had not heard of the term DHC and were unaware of the concept. The respondents' awareness was not associated with their age, sex, years of service, facility location, and percentage of treatment given to children aged five years and below. However, most dentists and dental therapists responded positively about incorporating most DHC characteristics into their current practice. Conclusions Most dentists and dental therapists serving the MOH primary oral healthcare facilities were unaware of the DHC, although most DHC characteristics have already been incorporated into their practice. This study provides evidence of the incorporation of the DHC into the MOH primary oral healthcare services and suggests an effort to increase the awareness of the workforce regarding the concept and its implementation.

Children's oral health and oral health care use during the first 2 years of the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has been associated with declines in children's oral health and oral health care use in 2020. The authors examined the pandemic effects on these outcomes into 2021.

METHODS

This cross-sectional study used data from the National Survey of Children's Health from 2017 through 2021. The authors compared parent's or caregiver's perceptions of the child's oral health and reported dental problems and dental visits across years, adjusting for child and household covariates and state of residence. The authors evaluated potential heterogeneity across demographic and socioeconomic subgroups.

RESULTS

In 2021, parents and caregivers were still more likely to perceive children's oral health as poor (odds ratio [OR], 1.90; 95% CI, 1.28 to 2.82) and less likely to report very good or excellent oral health (OR, 0.83; 95% CI, 0.76 to 0.92) than in 2019, similar to differences between 2020 and 2019. Dental visits were also less likely in 2021 than 2019 (OR, 0.74; 95% CI, 0.66 to 0.83). These differences between 2021 and 2019 were not explained by prepandemic trends and were observed across a range of demographic and socioeconomic subgroups.

CONCLUSIONS

Children's oral health as perceived by parents and caregivers and oral health care use were still worse in 2021 than before the pandemic both overall and across demographic and socioeconomic subgroups.

PRACTICAL IMPLICATIONS

The persistent adverse effects of the COVID-19 pandemic on children's oral health as perceived by parents and caregivers and shown through dental visits highlight the need to improve oral health care access and use and to evaluate the long-term effects of the pandemic on children's oral health.

Association between Community Social Capital and Access to Dental Check-Ups among Elementary School Children in Japan

The association between parental social capital and a child's access to dental check-ups has been reported, but few studies have focused on dental check-ups. The present study investigated the association between parental social capital and access to dental check-ups among first-grade elementary school children (6-7 years old) in Japan. We analyzed cross-sectional data of first-grade elementary school children (6-7 years old) in Adachi City, Tokyo, Japan. Community social capital (the total score of social trust, cohesion, mutual aid) and child's dental check-ups (dental check-ups for purposes other than treatment at least once a year) were assessed by questionnaire surveys for parents of the first graders from all 69 elementary schools in 2017 (n = 5260; response rate: 81.6%) and 2019 (n = 5130; response rate: 78.8%). Multilevel Poisson regression analysis, adjusted for children's age in months, gender, mother's educational attainment, mother's employment status, having siblings, living with grandparents, and the density of dental clinics in the school district, was applied. Of the 7936 respondents included in the analysis, 82.7% of children received dental check-ups at least once a year. Individual-level social capital was positively associated with children's dental check-up utilization (prevalence ratio, PR = 0.935 per one interquartile range, IQR; 95% confidence interval, CI: 0.877, 0.996). Community-level social capital was not significantly associated with children's dental check-up utilization (PR = 0.934 per one IQR; 95% CI: 0.865, 1.008). Promoting individual-level social capital, but not community-level social capital, may improve dental check-ups among elementary school children in Japan.

69th Annual ORCA Congress 2022

The impact of the coronavirus disease 2019 (COVID-19) pandemic on dental caries is unknown. We investigated the effect of the pandemic on child dental caries in Japan by comparing the increase in dental caries from fourth to sixth grade between two cohorts, COVID-19 exposed cohort and COVID-19 unexposed cohort, using difference-in-differences analysis. Longitudinal data that followed elementary school children in Adachi City, Tokyo, were analyzed. The analysis consisted of two cohorts: those who were in fourth grade in 2016 and sixth grade in 2018 (COVID-19 unexposed cohort, N = 399) and those who were in fourth grade in 2018 and sixth grade in 2020 (COVID-19 exposed cohort, N = 3,082). Children's dental caries were examined by school dentists. A difference-in-differences analysis, adjusting for time-variant variables, i.e., household socioeconomic status, children's oral health behavior, and caregivers' psychological distress, was performed. In fourth grade, the number of Decayed, Missing, and Filled permanent Teeth (DMFT) was not different between the COVID-19 unexposed and exposed cohorts (mean = 0.241 and 0.242, respectively). In sixth grade, DMFT increased by 0.067 in the COVID-19 unexposed cohort and 0.180 in the COVID-19 exposed cohort. The interaction term of grade and cohorts for caries by difference-in-differences analysis showed that dental caries among the COVID-19 exposed cohort showed a significant increase in the number of dental caries by 0.116 (95% confidence interval 0.015, 0.216) compared to the COVID-19 unexposed cohort. Child dental caries slightly increased after the pandemic. Studies with longer follow-ups are needed to evaluate the impact of the pandemic on child dental caries.

Population Impact of Sugar-Sweetened Beverages on Dental Caries and Overweight/Obesity in Australian Children

KNOWLEDGE TRANSFER STATEMENT

The reported findings greatly consolidated evidence of detrimental effects of sugars intake on child oral health and overweight and obesity, some of the most prevalent chronic conditions in children. Evidence on population impact of sugars intake is directly informative to policy makers and the public about the potential impact of population-based programs targeting sugars intake to prevent dental caries and overweight and obesity.

The Role of Parenting Practices on the Parent Perceived Impact of Child Oral Health on Family Wellbeing

Background: Family characteristics and parenting practices could significantly influence child oral health and the impact of child oral health on family wellbeing. Aim: To determine the association between parenting practices and parent-perceived impact of children’s oral health condition on family wellbeing. Design: A cross-sectional survey was conducted among 1539 school children in India. Parents answered the short form of FIS (Family Impact Scale), and PCRQ (parent–child relationship questionnaire) to assess the impact of the child’s oral health on family and parenting practices, respectively. Two factors emerged on factor analysis of PCRQ: ‘Positive parenting’ and ‘Power assertive parenting’. The intra-oral examination was conducted for children to assess their dental caries experience and gingival health status. Unadjusted linear regression and hierarchical multiple regression analysis were used to determine the influence of parenting practices on FIS. Results: An increase in power assertion (B = 1.16) parenting was associated with increased FIS scores indicating a higher adverse impact of the child’s oral health on family wellbeing when parents used more power assertive parenting practices. On the other hand, an increase in positive parenting (B = −1.27) was associated with decreased FIS scores, indicating a lesser impact of child’s oral health on family wellbeing when parents used more positive parenting practices. Conclusions: Parenting practices were associated with parents’ perceptions of the effect of children’s oral health on family wellbeing.

Comparison of Different Methods of Education in the Adoption of Oral Health Care Knowledge

AIM

The scope of this study was to determine if there is a critical distinction in the usage of lectures, videos, and pamphlets as educational material utilized in the adoption of oral health care knowledge.

MATERIALS AND METHODS

Three-hundred and thirty children from ages 11 to 13 from the city of Split, Croatia completed the questionnaire on oral health care knowledge. Consequently, they were educated by randomly using a method: lecture, pamphlet, or video. Finally, after education, their knowledge was tested again.

RESULTS

Different statistical tests were used for comparison of different sets of data. The Wilcoxon signed-rank test showed a statistically significant difference (p ˂ 0.001) compared to the results before and after education. The Kruskal-Wallis test comparing knowledge outcomes after three different types of education: video, lecture, and pamphlet, showed a statistically significant difference in the final knowledge between groups (p ˂ 0.05). A pairwise comparison between different types of education showed a significant statistical difference between education conducted by pamphlet and video material (p = 0.003) and pamphlet and lecture (p = 0.006). No difference was observed between the level of knowledge acquired through video material education and lectures (p = 0.928).

CONCLUSION

Videos and lectures as means of education showed equal effectiveness in the adoption of oral health care knowledge, while the pamphlet was a method that proved to be less effective.

Evaluating the environmental impact of the Welsh national childhood oral health improvement programme, Designed to Smile

INTRODUCTION

Designed to Smile (D2S) is a national oral health improvement programme, aimed to reduce the prevalence of dental caries in young children in Wales. D2S has a responsibility to consider the environmental impact of the service it provides and demonstrate adherence to the sustainable development principle legislated within the Wellbeing of Future Generations (Wales) Act.

OBJECTIVE

To review the environmental impact of D2S by estimating the carbon footprint of the programme and identify carbon hotspots for future targeted action.

RESEARCH DESIGN

Process mapping identified the steps to deliver the supervised toothbrushing and fluoride varnish elements of D2S. Annual estimates of business travel mileage, financial spend on procurement, total number of plastic consumables and waste disposal were made. An online survey enabled calculation of staff commuting behaviour. These contributors were converted to carbon emissions using established carbon conversion factors.

RESULTS

The annual carbon footprint of D2S was estimated at 388 tonnes of CO²e (tCO²e) with 31% attributed to staff travel, 23% to business travel and 46% to procurement. An estimated 1 million plastic items were distributed.

CONCLUSION

By promoting good oral care and preventing the need for future carbon intensive restorative dental treatments, D2S exemplifies a sustainable model of healthcare. Adopting reduce, reuse, recycle principles for plastic consumables and introducing sustainable procurement procedures could lead to further decarbonisation and reduction in plastic waste.

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.

Association between malocclusion and orofacial myofunctional disorders of pre-school children in Latvia

OBJECTS

Abnormal use of muscles of tongue and lips is called orofacial myofunctional disorders (OMD). In this study, we aimed to investigate the interrelation between occlusal findings and OMD in primary and mixed dentition and to find out the reasons for malocclusions, and the effect modification of these associations by the number of sources that parents used to receive the information on child oral health issues (NSI).

SETTING AND SAMPLE POPULATION

Cross-sectional study was performed in one kindergarten in Latvia (cluster sampling). The study sample comprised 141 children-mothers' pairs of pre-school children aged 4-7 years.

MATERIALS AND METHODS

Children' myofunctional situation, occlusion and speech defects were assessed during an examination. Children's mothers were interviewed on their socio-demographic situation, feeding and habits of the child, history of diseases and NSI. Multiple logistic regression models adjusted for lip power, swallowing, breathing and speech cases of long respiratory diseases, age and gender were built to investigate associations between the types of occlusion and OMD/health characteristics. Effect modification of these associations by NSI was analysed.

RESULTS

Types of occlusion associated with OMD/health characteristics were as follows: normal occlusion with prolonged respiratory diseases (odds ratio, OR = 0.345 [95% confidence interval, CI 0.16; 0.75]); combined type with tongue thrust habits (OR = 3.11 [0.99; 9.90]), lip-closing strength (OR = 0.99 [0.98; 0.99]); and cross-bite with speech (OR = 3.55 [1.07; 11.78]). These associations remained stable when parents used two or less sources of information on children's oral health.

CONCLUSIONS

To facilitate occlusal stability, early interdisciplinary examinations should be performed to prevent time-consuming and cost-consuming treatment.

The Impact of Policy Modifiable Factors on Inequalities in Rates of Child Dental Caries in Australia

Background: Poor oral health in childhood can lead to adverse impacts later in life. We aimed to estimate the prevalence and population distribution of childhood dental caries in Australia and investigate factors that might ameliorate inequalities. Methods: Data from the nationally representative birth cohort Longitudinal Study of Australian Children (N = 5107), using questions assessing: The experience of dental caries during each biennial follow-up period (2–3 years to 10–11 years), socioeconomic position (SEP), and policy modifiable oral health factors. Results: The odds of dental caries were higher for children with lowest vs. highest SEP (adjusted OR (adjOR) 1.92, 95% CI 1.49–2.46), and lower where water was fluoridated to recommended levels (adjOR 0.53, 95% CI 0.43–0.64). There was no evidence of an association between caries experience and either reported sugary diet or tooth brushing. When SEP and fluoridation were considered in conjunction, compared to the highest SEP group with water fluoridation children in the lowest SEP with fluoridation had adjOR 1.54 for caries, (95% CI 1.14–2.07), and children in the lowest SEP without fluoridation had adjOR 4.06 (95% CI 2.88–5.42). For patterns of service use: The highest SEP group reported a greater percentage of service use in the absence of caries. Conclusions: Dental caries appears prevalent and is socially distributed in Australia. Policy efforts should consider how to ensure that children with dental caries receive adequate prevention and early care with equitable uptake.

Fluoridated Water Modifies the Effect of Breastfeeding on Dental Caries

Breastfeeding is important for health and development. Yet, the interaction between breastfeeding duration and usage of fluoridated water on caries experience has not been investigated. This study examined exposure to fluoridation as an effect modifier of the association between breastfeeding duration and caries. The 2012 to 2014 national population-based study of Australian children involved parental questionnaires and oral epidemiological assessment. Children were grouped by parent-reported breastfeeding duration into minimal (none or <1 mo), breastfed for 1 to <6 mo, breastfed for 6 to 24 mo, and sustained (>24 mo). Residential history and main water source used for the first 2 y of life were collected to group children into exposed (WF) and nonexposed (NF) to fluoridation. Socioeconomic status, infant formula feeding, and sugar-sweetened beverage (SSB) consumption data were collected. The prevalence and severity of caries in children aged 5 to 6 y were primary outcomes. Multivariable regression models with robust error estimation were generated to compute prevalence ratios (PRs) and mean ratios (MRs) for 3 breastfeeding groups against the reference (breastfed for 6-24 mo). Of the 5- to 6-y-old children, 2,721 were in the WF and 1,737 were in the NF groups. The groups had comparable distributions of socioeconomic factors, infant formula feeding, and SSB consumption. There were U-shape distributions of caries experience among breastfeeding groups, being more pronounced among NF children. Among NF children, the minimal and sustained breastfeeding groups had significantly higher PR (1.4 [1.1-1.9] and 1.8 [1.4-2.4]) and MR (2.1 [1.4-3.3] and 2.4 [1.4-4.1]) than the reference group. However, among the WF children, this association between breastfeeding duration and caries attenuated after adjustment for other factors. The study contributes evidence of a nonlinear (U-shape) association between breastfeeding duration and dental caries. Early life exposure to fluoridated drinking water attenuated the potential cariogenic effect of both lack of and sustained breastfeeding.

Psychosocial factors and oral health practices of preschool-aged children: a qualitative study with Hispanic mothers

OBJECTIVE

This qualitative study sought to gain an in-depth understanding of Hispanic mother's parenting experiences and perceptions about select psychosocial factors. How psychosocial factors influence mothers' engagement in recommended oral health-related behaviors for their preschool-aged children (3-5 years) was explored. Psychosocial resources and barriers explored included maternal knowledge about children's oral health, beliefs such as perceived self-efficacy and health locus of control, and parenting experience and stress.

DESIGN

Six focus groups and one individual interview with lower-income, Hispanic mothers of preschoolers (n = 36 total participants) were conducted in Spanish at a community health clinic on the California-Mexico border during summer 2010. A bilingual dentist led all sessions using a set of open-ended guiding questions. All sessions were audio-taped, translated and transcribed in English. Transcripts were coded and analyzed for common themes.

RESULT(S)

Six themes were identified around dental knowledge, the mothers' primary role in performing the child's oral hygiene among multiple caregiving priorities, parenting challenges, perceived self-efficacy, perceived future outlook for their child's oral health, and family influences. Mothers recognized the importance of caring for primary teeth. However, few were knowledgeable about preventive practices to promote young children's oral health, such as the recommended ages for brushing or first dental visit. Mothers that were more knowledgeable expressed feeling more efficacious about maintaining their child's oral hygiene. All mothers believed they were primarily responsible for their child's oral health, and most held positive future expectations for their child's oral health.

CONCLUSION

These findings provide insight into how Hispanic mothers of young children perceive their role as caregiver. Maternal knowledge and perceptions affect their ability to care for their child's oral health and should be accounted for in future interventions.

Oral health of schoolchildren in Western Australia

BACKGROUND

The West Australian School Dental Service (SDS) provides free, statewide, primary dental care to schoolchildren aged 5-17 years. This study reports on an evaluation of the oral health of children examined during the 2014 calendar year.

METHODS

Children were sampled, based on their date of birth, and SDS clinicians collected the clinical information. Weighted mean values of caries experience were presented. Negative binomial regression modelling was undertaken to test for factors of significance in the rate of caries occurrence.

RESULTS

Data from children aged 5-15 years were used (girls = 4616, boys = 4900). Mean dmft (5-10-year-olds), 1.42 SE 0.03; mean DMFT (6-15-year-olds), 0.51 SE 0.01. Negative binomial regression model of permanent tooth caries found higher rates of caries in children who were from non-fluoridated areas (RR 2.1); Aboriginal (RR 2.4); had gingival inflammation (RR 1.5); lower ICSEA level (RR 1.4); and recalled at more than 24-month interval (RR 1.8).

CONCLUSIONS

The study highlighted poor dental health associated with living in non-fluoridated areas, Aboriginal identity, poor oral hygiene, lower socioeconomic level and having extended intervals between dental checkups. Timely assessments and preventive measures targeted at groups, including extending community water fluoridation, may assist in further improving the oral health of children in Western Australia.

Breaking down the barriers: a qualitative study to understand child oral health in refugee and migrant communities in Australia

OBJECTIVE

Australia is an increasingly multicultural nation. Never before has the dental workforce been exposed to such language, cultural, religious and ethnic diversity. There is evidence that refugee and migrant children experience significantly poorer oral health than the nonmigrant population. However, little is known about the oral health knowledge, practices and beliefs of parents with young children from refugee and migrant backgrounds. The aim of this study was to identify the sociocultural influences on child oral health in these communities.

DESIGN

Participatory and qualitative research methods were utilised. Partnerships were established with community agencies representing migrants from Iraq, Lebanon and Pakistan. Focus group discussions and semi-structured interviews were conducted with community members. Qualitative data were analysed thematically, combining focus group and interview data.

RESULTS

Over 100 women participated in focus groups (n = 11) and semi-structured interviews (n = 7). Key findings included the knowledge, beliefs and practices concerning: caries risk factors, oral health practices and oral health literacy. Despite mothers' knowledge of the major causes of poor oral health - dietary changes, confusion about child oral hygiene practices and limited oral health literacy all influenced child oral health outcomes.

CONCLUSION

This culturally competent qualitative study explores the sociocultural factors influencing child oral health in refugee and migrant communities. Understanding and acknowledging these factors are a prerequisite to determining where and how to intervene to improve oral health. Furthermore, it has implications for both dental and non-dental health professionals working to reduce health inequalities within such communities.