Exploring the Threefold Viewpoint on Children's Oral Health in a Cross-Sectional Study

Oral health is situated within the framework of the global health agenda, addressing facets pertaining to well-being and quality of life. The research is based on the need to address variables at the community level to improve schoolchildren's oral health and promote healthy behaviors and aims to carry out an in-depth analysis from the perspective of the factors that influence children's oral health. Step 1, designed by the World Health Organization, was utilized. An easy-to-use web interface was created for data collection. The statistical analysis consisted of using multinomial and binominal logistic regression models. The level of education of the adult has a high probability of influencing the consumption of unhealthy or healthy foods, it has a significant probability of exerting influence on social or medical problems and a correlation was found between the level of academic education and the pattern of dental visits. The development of health-promoting behaviors begins in childhood and involves parents, who have an essential role in the education of their children. Oral health promotion programs in schools need to target the child-adult-teacher-dentist relationships. Taking into consideration the aforementioned, a threefold viewpoint is necessary for the development of a national program aimed at promoting the oral health of schoolchildren in Romania.

Interprofessional Survey on Knowledge and Attitudes on Oral Health among Nurses in France

PURPOSE

Healthcare professionals (HCPs) play a key role in improving the health literacy of patients. Since oral health is an essential part of overall health, the objective of this study was to assess the knowledge and attitudes about oral health among registered nurses.

MATERIALS AND METHODS

A four-component questionnaire was used to assess the oral health training, oral health knowledge and attitudes of registered nurses. Participants were recruited from the city of Montpellier, France, and the surrounding area between May and June 2022 via e-mail and social media.

RESULTS

In total, 416 responses were included in our study. Only 35.8% of nurses reported that they had received specific training on oral health and 24.3% had never advised patients to consult a dentist. Participants demonstrated good overall knowledge, but stated there were weaknesses in a variety of areas, such as oral health in children. The nurses proposed methods to improve understanding of the importance of oral health, namely by setting up training courses and better interdisciplinary collaboration.

CONCLUSION

Our study showed that some aspects of oral health are not well understood by nurses. Initial training should be improved and supplemental training should be offered to improve the knowledge, attitude and practices of nurses in order to improve patient care.

Native American Community Perspectives on Oral Health Access: Understanding the Impact of Rurality

PURPOSE

Oral health disparities related to access persist for American Indian/Alaska Native (AI/AN) communities compared to the general population, especially in rural areas of the United States. The objective of this study was to better understand community perspectives of oral health, how rurality impacts access to care, and attitudes towards the implementation of dental therapists in Oklahoma, particularly among the AI/AN population.

METHODS

A descriptive, observational study design was utilized. An exploratory survey was conducted online and comprised of qualitative and quantitative data. The total frequencies and percentages were evaluated for the quantitative questions. The qualitative data was analyzed using thematic analysis. Utilizing descriptive and qualitative research methods, the focus was to describe the experiences of the respondents and their characteristics related to oral health in Oklahoma.

RESULTS

A total of 201 responses were obtained, where 65% (n = 131) identified as an enrolled member or employee of a tribe represented in Oklahoma. Key qualitative themes included community access to care, community concerns, and community motivated solutions.

CONCLUSIONS

AI/AN communities are an underserved group in healthcare. Although communities in rural areas face major barriers to oral health services, evidence-based solutions can be implemented.

Improving oral health of children in four Balkan countries: A qualitative study among health professionals

Data from the WHO show that the oral health situation for children in the Balkan region of Europe is poor. This study aims to identify obstacles that prevent the implementation of an effective oral health program for children in the Balkan area. The study investigates the challenges that people encounter in increasing awareness, attending to dental care, and complying with examinations.

Methods

This qualitative study targeted experts in preventive dentistry and oral health promotion in four countries in the Balkan region. Purposive sampling was used to recruit the participants. Data were collected in 2021 using individual in-depth interviews with participants from Albania, Bosnia and Herzegovina, Croatia, and Serbia. The study applied the thematic analysis method.

Results

The experts reported four main challenges that hindered the implementation of a prevention program and regular patient attendance: (1) lack of knowledge, (2) the exclusion of oral health from overall health, (3) organization of services, and (4) skepticism of fluoride. The participants identified knowledge gaps among the general population, dental staff, and other health professionals regarding the prevention of oral diseases.

Conclusion

The findings of this study may be used to promote and improve oral health among children in the identified areas and to benefit people in the region and elsewhere. This study sheds light on the existing barriers in a region where people lack information.

Early Preventive Dental Visits: Do They Reduce Future Operative Treatments?

This study assessed the longitudinal impact of early preventive dental visits on the number of dental operative procedures in a prevention-oriented pediatric dental practice. Inclusion criteria consisted of patients zero to four years of age with at least two years of preventive services provided by the practice. Early preventive visits were the intervention and dental operative procedures were the assessed outcome. The goal was to determine if preventive visits at an early age decreased the number of operative procedures needed by the patient. The patients were divided into two groups: those with older siblings in the practice and those without older siblings in the practice. A secondary outcome was to compare these two patient groups to determine if a child who had older siblings previously treated in this preventive practice had better outcomes than those without siblings in the practice. ANCOVA tests were used to compare the average number of operative procedures in two age groups (<2 years and ≥2 years), and for those with and without dental insurance, in addition to children being younger sibling versus children without sibling, adjusting for the effect of covariates. The study sample consisted of 363 pediatric patients. Patients’ age at first visit ranged from 0 to 4 years old (mean = 2.13; SD = 1.15). The average number of operative procedures per year increased as the age at first visit increased (p < 0.05). The average number of operative procedures in two age groups (<2 years and ≥2 years) differed (p < 0.05) with those whose age at first visit ≥2 years experiencing more dental operative procedures than the younger group. The average number of operative procedures was similar between younger siblings (mean = 1.91; SD = 7.44) and children without siblings (mean = 1.54; SD = 2.1) (p > 0.05). The difference in the average number of operative procedures in children with insurance (mean = 1.59; SD = 5.25) and children without insurance (mean = 1.58; SD = 2.38) was non-significant (p > 0.05). More dental cleaning examinations were associated with fewer dental operative procedures (p < 0.05). These findings demonstrate that dental examinations before two years of age and more dental cleaning examinations lead to a decrease in the number of dental operative procedures needed by children.

Oral Health Education and Promotion Activities by Early Head Start Programs in the United States: A systematic review

Purpose: Dental caries is a non-communicable, preventable disease that disproportionately affects low-income children in the United States (US). The purpose of this systematic review was to describe oral health education and promotion activities designed to prevent early childhood caries (ECC) provided by Early Head Start (EHS) programs in the United States.Methods: Five databases were searched including CINAHL, Dentistry & Oral Sciences Source through EBSCO, PubMed, Google Scholar, and the Wiley Online Library, to identify peer-reviewed quantitative studies published in English on oral health education and promotion activities within EHS programs from 2000 to 2019. Studies were assessed for eligibility using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram (PRISMA). Two researchers independently evaluated the included studies.Results: The initial search yielded a total of 363 articles. Following the screening process, five studies met the inclusion criteria (observational, n=2; quasi-experimental, n=3). The main outcome measures included oral health knowledge, attitudes and behaviors, oral health education, oral health promotion, and oral health activities. Three studies investigated the effectiveness of oral health education and promotion interventions among EHS staff and parents. Two studies examined oral health activities such as education, toothbrushing instructions, toothpaste use, dietary education, and dental assessment.Conclusion: Studies that focused on increasing pediatric oral health knowledge and practice behaviors among both EHS staff members and parents reflected positive outcomes. Ongoing research is needed to examine the effectiveness of oral health education and promotion activities as they relate to the oral health outcomes of children enrolled in EHS programs.

Paediatric Oral Health during and after the COVID-19 Pandemic

BACKGROUND

During the period of health emergency linked to the current COVID-19 pandemic, the paediatric dentists' management of oral health problems in children must have as primary objective the control of the spread of the disease according to specific protocols aimed at minimizing the risk of viral transmission.

AIM

This paper examines the possible clinical conditions that may require intervention by the paediatric dentist, distinguishing clinical situations that fall into the category of paediatric dental emergencies from conditions of oral pathologies that normally do not represent an emergency. The definition of rigorous and highly effective infection control protocols in the dental settings must therefore be complemented by the development and strengthening of remote communication techniques with the parents, who must be adequately educated on preventive and palliative measures for the management of their children's oral health, with the aim of postponing clinical attendance to when the circumstances become favourable.

CONCLUSIONS

The experience gained with these approaches and models of treatment, where remote interaction techniques play a central role, will hone the communication skills of the paediatric dentist and will retain its usefulness even at the end of the current emergency period.

Practical Guidelines for Physicians in Promoting Oral Health in Frail Older Adults

Good oral health in old age is particularly important for maintaining adequate oral function, preventing pain and discomfort, controlling localized or systemic inflammation, sustaining social interaction, and preserving quality of life. Given that oral health is an integral part of general health and well-being, and that major chronic systemic and oral diseases share common risk factors, oral health prevention and promotion should be embedded within routine medical assessment and care provision. The role of medical physicians, particularly primary care physicians, geriatricians, and elderly care physicians, in community and long-term care facilities in assessing and promoting oral health in frail older adults is critical and has been emphasized in recent European recommendations. All physicians should appreciate the importance of oral health and incorporate an initial oral health screening into routine medical assessment and care. A short interview with patients and carers on current oral health practices may help to assess the risk for rapid oral health deterioration. The interview should be followed by an oral health assessment, using validated tools, for nondental health care providers. Based on these findings, the physician should decide on necessary follow-up procedures, which may include oral health counseling and/or dental referral. Oral health counseling should include advice on daily oral, mucosal, and denture hygiene; denture maintenance; dietary advice; smoking cessation; limitation of harmful alcohol consumption; management of xerostomia; and frequent dental review. To enable physicians to perform the tasks recommended in this publication, appropriate teaching at both undergraduate and postgraduate levels must be delivered in addition to provision of appropriate continuing education courses.

Oral Health Behavior Change in Mexican-American Caregivers: A Community-Based Intervention Study

An oral health prevention intervention was conducted with Mexican-American (MA) caregivers, focused on improving their oral health knowledge, behavior, and self-efficacy. Five in-person intervention sessions were conducted with caregivers, followed by a 15 min skill-building exercise. A goal-setting sheet was provided, and two goals were chosen for fulfilment during the three month intervention period. The data on parental oral health knowledge, behavior, and self-efficacy were collected pre- and post-intervention using a portion of Basic Factors Research Questionnaire (BRFQ). Paired t-tests were conducted to test significant differences in the means of pre- and post-intervention oral health behavior, knowledge, and self-efficacy scores, and pre- and post-intervention individual item scores. Forty six primary caregivers were enrolled. There were significant differences in the means of pre- and post-intervention oral health knowledge (p = 0.003), oral health behavior (p = 0.0005), and self-efficacy scores (p = 0.001). The individual item mean scores showed that there was a significant increase in the number of times caregivers checked for spots (p = 0.016) and a significant decrease in the consumption of sweet or sugary drinks (p = 0.032) post-intervention. Most of the caregivers believed that cavities were caused by germs in the mouth (p = 0.001), sharing utensils with children was bad for their teeth (p < 0.001), and fluoride toothpaste was best for a child’s teeth (p < 0.001). The intervention resulted in improved caregiver oral health knowledge, behavior, and self-efficacy.

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.

Evaluating Oral Health in Pregnant Women: Knowledge, attitudes and practices of health professionals

Purpose: Complex physiological changes occur during pregnancy thus increasing the risk of periodontitis and potentially adverse pregnancy outcomes. The purpose of this study was to assess prenatal health care professionals' levels of knowledge regarding oral health and its effect on pregnancy outcomes, examine their current practices in evaluating oral health, and determine their attitudes towards a multidisciplinary approach to providing comprehensive prenatal care.Methods: Data was collected from a web-based survey administered to a convenience sample of prenatal health professionals in a healthcare organization located in the Midwestern United States. Responses were summarized with descriptive statistics. A knowledge score was utilized to compare midwives and nurse practitioners to physicians and residents.Results: Seventy-six prenatal health care professionals (n=76) agreed to participate for a response rate of 37%, with the majority (80%) of respondents considering oral health to be an important component of prenatal care. In regards to the inclusion of oral health in current practice, only 6% of the respondents "always" include an oral health history interview and only 7% "always" include a dental screening as part of prenatal care. A moderate correlation was found between the knowledge score and the frequency of including oral health history interviews during prenatal visits (correlation = 0.36, p=0.002).Conclusion: The majority of prenatal health care professionals surveyed were knowledgeable about oral health as it relates to prenatal care; however, a deficit was identified in current practice in regards to oral health history interviewing and conducting dental screenings. There is a need to implement best practice guidelines that include routine dental screenings and to engage pregnant women in oral health prevention practices. Optimal oral health requires a multidisciplinary approach in which dental hygienists can play a significant role by educating women's healthcare providers and raising awareness of the connection between oral health and pregnancy outcomes.

A Comparison of Oral Hygiene Products and Professional Care: A six-week randomized clinical trial

Purpose: To investigate the anti-gingivitis efficacy of a novel oral hygiene routine consisting of a two-step stannous fluoride dentifrice and hydrogen peroxide whitening gel system, an interactive oscillating-rotating electric toothbrush, and expanded polytetrafluoroethylene floss.Methods: A total of 52 participants (n=52;mean age 35.8±11.23 years) were enrolled in the study and randomized 1:1 to the experimental hygiene group or control (dental prophylaxis followed by use of standard sodium fluoride dentifrice and a manual toothbrush). Participants were instructed to brush twice daily; those in the experimental group were instructed to floss once daily. Oral examinations were conducted at Baseline, Week 2, Week 4, and Week 6.Results: Both groups experienced significant declines in the mean number of bleeding sites from Baseline at all time points, evident as early as Week 2. Bleeding sites continued to decline throughout the trial in the experimental group, whereas they showed an increasing trend between Weeks 2 and 6 in the control group. The experimental group had 55% fewer bleeding sites at Week 2, 85% fewer bleeding sites at Week 4, and 98% fewer bleeding sites at Week 6 (p<0.0001 for all) as compared to the control group. At Week 6, 84% of participants in the experimental group had no bleeding, while all participants in the control group had bleeding.Conclusion: The experimental oral hygiene group showed significantly greater reductions in gingival bleeding than the control oral hygiene group, with benefits seen as early as Week 2 and increasing over the six-week study.

Impact of State Workforce Policies on Underserved Patients' Access to Dental Care: A longitudinal study

Purpose: Dental diseases are almost entirely preventable, but discrepancies in access to oral healthcare limit the effectiveness of preventive interventions. Dental hygienists are strategically positioned to improve access to preventive dental procedures; however, state workforce policies determine their permitted clinical tasks.Methods: This study cross-referenced oral healthcare service use at Federally Qualified Health Centers (FQHCs) between 2004 and 2012 with the Dental Hygiene Professional Practice Index (DHPPI), which quantifies the various aspects of state policy environments for the dental hygiene workforce. More specifically, the study used generalized linear mixed-effects models to examine the influence of state policy environment on access to dental care at 958 FQHC grantees.Results: States with "favorable" policy environments consistently reported the highest proportion of FQHC patients accessing dental care services (18%), whereas states with "restrictive" environments reported the lowest proportion (12%).Conclusion: A smaller proportion of FQHC patients' receive dental examinations in states with restrictive state workforce policies; state lawmakers should frame workforce policies to protect public safety without limiting the oral health workforce's ability to provide important oral health services to underserved people.

Approximal caries increment in relation to baseline approximal caries prevalence among adolescents in Sweden with and without a school-based fluoride varnish programme

Objective

Approximal surfaces are a focal point for caries prevention among adolescents in Sweden and the aims of this study were therefore to evaluate approximal caries incidence and caries progression among adolescents with and without a three-year school-based fluoride varnish programme in relation to approximal caries prevalence at baseline.

Basic research design

In all, 758 (89%) 13-year-olds completed the three-year randomised controlled trial. They all used fluoride toothpaste at home and had regular dental check-ups at the public dental clinics.

Results

The mean approximal caries incidence for the adolescents who were caries free on these surfaces at baseline was 0.13 (SD 0.54) in the fluoride varnish group and 0.79 (1.93) in the control group. The corresponding values for those who had caries at baseline in these groups were 1.29 (2.21) and 2.62 (3.22) respectively. The latter two groups also had 0.34 (1.00) and 0.70 (1.13) approximal enamel lesions that progressed. All differences were statistically significant (p⟨0.001). Among those individuals who had approximal caries at baseline, double the number of early approximal enamel lesions in the control group progressed compared with the fluoride varnish group.

Conclusions

The school-based fluoride varnish programme inhibited new approximal lesions to a great extent and effectively kept approximal enamel lesions within the enamel among 13-16-year-olds. It is therefore recommended that such a programme is warranted when the approximal surfaces are still caries free in order to keep these surfaces free from caries and keep upcoming approximal enamel lesions within the enamel.

Dental Hygienists' Attitudes Toward the Obese Population

Purpose: To explore dental hygienists' attitudes toward the obese population and to determine whether there are differences in attitudes among those with different self-reported body images.Methods: The study population was dental hygienists whose email addresses were in the database of the California Dental Hygienists' Association (CDHA). CDHA distributed the electronic message containing study information, informed consent, and a link to the survey. The survey consisted of 14 items from the Fat Phobia Scale, 13 items from the Anti-fat Attitudes Questionnaire (AFAQ), 3 demographic questions, and 1 question on body image. Frequencies of responses for each survey item were calculated, and Likert-like scale responses from the AFAQ were analyzed to determine significant differences among self-reported body images.Results: Of the 6,248 email addresses in the CDHA database, 518 hygienists or 8% responded. Mild fat phobia was indicated by 57% of the word pair scores on the Fat Phobia Scale being higher than 2.50. On the AFAQ, 84% agreed to the statement, "People who weigh too much could lose at least some part of their weight through a little exercise." Significantly (p<0.05) more respondents who self-reported as overweight than underweight agreed to "I feel disgusted with myself when I gain weight" and "I worry about becoming fat," while more in the overweight than underweight category significantly (p<0.05) disagreed with "Fat people make me somewhat uncomfortable."Conclusion: Dental hygienists exhibited mildly negative attitudes toward the obese population. Curricula specific to the role of the dental hygienist in addressing the health effects of obesity are recommended.

Implications for Improving Oral Health Care Among Female Prisoners in Georgia's Correctional System

Georgia has the eighth-highest state rate of incarceration and fourth-highest number of prisoners in the country. Aside from receiving a dental examination at intake to assess oral health needs, there are no efforts to determine the barriers and determinants that contribute to the presenting oral health status of Georgia's state prisoners. Also, there is no prerelease planning to establish a health care home for prisoners being released back into the community to continue oral health care services in an effort to support successful reentry.This study assessed the barriers that impact N=98 female inmates' access to oral health care, prior to incarceration, within Georgia's prison system using a 21-item survey developed by a division of an academic institution and administered by the staff of a state department. Majority of the survey respondents reported that they do not have a regular dental provider (83%), lack insurance coverage (66%), and had their last dental visit more than a year ago because they did not have money for service or treatment (64%). The data collected from this study will be utilized to inform future project efforts to both reduce costs and increase access to oral health care for Georgia's uninsured and underinsured, and especially the incarcerated and reentry populations.