Special needs, special risks? A comparative oral health study in children and adolescents.

Valuing oral health: Accomplishments and challenges

BackgroundDespite overall improvements in oral health, a large number of children in United Kingdom (UK) are affected by dental caries; and the implementation of oral health promotion in some families remains a challenge. As such, children from those families suffer high caries rates, and are frequently referred for tooth extraction under General Anaesthesia (GA), one of the commonest reasons for paediatric hospital admissions. The aim of this investigation is to explore referring primary care General Dental Practitioners’ (GDPs) views and experiences in trying to promote better oral health for those children.MethodA qualitative study, utilizing face-to-face, semi-structured interviews with GDPs in three London boroughs who refer children for extraction of decayed teeth under GA selected based on referral rate. Qualitative Framework Analysis was used to present the results.ResultsEighteen GDPs (56% male) were interviewed: average age 42 years (range: 26–73 years). informants reported challenges to promotion of oral health categorised as: (1) child’s young age, poor cooperation, and high treatment need; (2) parental skills to face up to modern day challenges and poor attitudes towards good oral health (3); social inequality, exclusion and cultural barriers in immigrant families; (4) National Health Services (NHS) primary care practice remuneration, constraints and training; (5) inadequate secondary care communication and engagement; and (6) failure in establishing national policy to grasp the width and depth of the problem.ConclusionGDPs feel frustrated and isolated in their efforts to promote oral health in those children. These findings suggest difficult challenges on all fronts. Reform of preventive dentistry funding and delivery, as well as a multiagency multidimensional approach that is mindful of the social determinants of children’s oral health and barriers to application of oral and wider health initiatives are needed to address this important public health issue.

ObjectivesThis study aimed to investigate the performance of oral assessment and health care education at nursing schools across Japan to identify problems and the need for oral health professional support. MethodsThe participants were the academic staff in charge of oral health care education in the basic, adult, gerontological, and home nursing fields of 295 schools in Japan that offered a bachelor's degree in nursing. A questionnaire was sent to 1180 heads of the nursing fields of these schools. They were requested to have oral health care educators complete the survey; data on the performance of oral assessment and health care education and human resources allocated were collected through a questionnaire. ResultsA total of 311 (26%) questionnaires were returned, 196 (63%) of which were completed by oral health care educators. Regarding the performance of oral assessment education, the majority (71%) of them spent less than 2 hours in teaching, and only 24.5% taught the usage of oral assessment tools. Regarding the performance of oral health care education, more than 90% spent less than 2 hours in lecture-based and practical oral health care education, respectively. Less than half taught the association of periodontal diseases with diabetes and cardiovascular diseases and use of fluoride for caries prevention in the lectures, and only approximately 30% taught the usage of an interspace brush or dental floss. Moreover, less than 10% of oral health professionals taught oral health care in lectures or practical oral health care. ConclusionsThis study revealed problems associated with oral assessment and health care education in Japanese nursing schools. To address these, support from oral health care professionals is required. Further studies are also required to reveal problems in oral assessment and health care education in other nursing schools that do not offer a bachelor's degree programme in Japan and other countries.

Population oral health (OH) improvements depend on successful, coordinated execution of oral health promotion (OHP) programs by both oral and general health professionals with key competencies (skills, abilities, knowledge and values). This study explored multidisciplinary professionals' perspectives of the competencies required for the successful implementation of a community-based OHP program called Smiles 4 Miles (S4M) in early childhood settings in Victoria, Australia. Convenience sampling was used to recruit multidisciplinary professionals working in the S4M early childhood health promotion program in Victoria. Semi-structured focus groups were conducted with program managers/coordinators (n=26) from 21 S4M sites and the state-wide program coordination team (n=5). Focus groups explored OHP competency needs, capacity to promote child OH and strategies for enhancing OHP competencies. The competencies identified through focus groups were then compared to the International Union for Health Promotion and Education (IUHPE) competencies framework. Strategies to enhance individual and organisational OHP competencies included intersectoral collaborations; working in multidisciplinary teams; support networks and partnerships; sharing skills and expertise between health professionals. The OHP competencies identified by the participants were consistent with key IUHPE domains including ethical values and health promotion knowledge base underpinning, enabling change, advocacy for health, mediating through partnerships, communication, leadership, assessment, planning, implementation, evaluation and research. A multidisciplinary workforce based in community settings can play key and complementary roles in OHP and widen avenues for oral disease prevention. SO WHAT?: Integrated collaborative workforce models involving multidisciplinary professionals beyond the OH sector can more effectively support efforts to address the burden of oral disease.

A comparison of community based preventative services to improve child dental health

Dental Surgeons working in public sector have an important role to play in school dental health pro-gram to reinstitute the oral and dental health of growing population of India. Even though the oral health policy was drafted in India in 1995, it was not implemented till this date (1). It is im-portant to enhance the knowledge about good oral health in teachers and parents by caring out workshops and seminars on oral and dental health by dental Surgeons working in public health sector. Dental surgeons working in public health sector should carry out oral screening to improve the future of oral health care in India (2). Mobile den-tal unit is an effective method to render oral and dental health-care in the public sector and it should be implemented in school set up in multi-ple situations such as educating school children regarding oral and dental health, screening of school children for various oral diseases, school and community dental health program(3).In an interventional study conducted among rural school children in Nalgonda district to assess the oral health promotion, it was interfered that the School teachers may be utilized as good medium for oral health promotion among school children in India and other developing countries(4). The following recommendations should be incor-porated in school health program in India. The government should incorporate dental surgeons in school health programs to give lecture on oral health, oral hygiene, plaque control, oral and den-tal diseases, oral cancer or smokeless tobacco use and hazards counseling and topical fluoride appli-cation. The government should incorporate oral and dental health related topic in School curric-ulum. Compulsory fitness regarding oral and den-tal health should be made mandatory for class promotion. Dental Surgeons play an important role in recognizing child abuse in school set up (5). Dentists should evaluate child abuse cases and child abuse cases will present clinically as physical abuse, neglect, sexual abuse and emotional abuse (6). The straight path to accomplish the above goals is achieved through strong support from policy makers and professional support from den-tal surgeons working in public and private sector in India.

Low oral health literacy (OHL) plays a crucial role in contributing to poor oral health outcomes. However, limited studies have focused on school-age children. This study aims to investigate the association between OHL among sixth-grade primary school students and oral health outcomes, and to identify factors related to inadequate OHL. A cross-sectional study was conducted among 408 Thai sixth-grade primary school students (aged 12 years) in Pathum Thani Province, Thailand. Participants completed the Test of Functional Health Literacy in Dentistry for Primary School Children (P-TOFHLiD) to assess OHL and underwent oral examinations. Oral health behaviors were collected through participant interviews and caregiver questionnaires, while demographic data were obtained from caregiver questionnaires. Chi-square tests, Spearman's correlation, and logistic regression were used to assess associations between OHL and oral health outcomes, and to identify risk factors for inadequate OHL. The mean P-TOFHLiD score was 19.4 (SD = 4.7), with a median of 21 (IQR: 17-23). 59.6% had inadequate OHL (score < 21). Chi-square tests showed that participants with inadequate OHL were more likely to have untreated caries in permanent teeth (p < 0.001), first permanent molars with disease-related pulp exposure (p = 0.001), poorer oral hygiene (p < 0.001), and consumption of cariogenic snacks (p < 0.001), while no associations were found with missing or filled permanent teeth, brushing frequency, fluoridated toothpaste use, or dental service utilization. Logistic regression showed that inadequate OHL increased the odds of having untreated caries in permanent teeth (AOR = 8.30, 95% CI: 4.89-14.11), first permanent molars with disease-related pulp exposure (AOR = 20.63, 95% CI: 4.84-87.91), and poor oral hygiene (AOR = 2.08, 95% CI: 1.20-3.59). Lower Grade Point Average (GPA) (AOR = 0.01, 95% CI: 0.00-0.02) and low family income (< 10,000 Baht) (AOR = 3.56, 95% CI: 1.62-7.82) were associated with increased risk of inadequate OHL. Inadequate OHL was linked to adverse oral health outcomes. Lower GPA and low family income were identified as risk factors for inadequate OHL. These findings emphasize the need for targeted interventions to strengthen OHL and improve children's oral health. Not applicable.

Introduction Despite overall improvements in oral health, the number of children admitted to hospital for extraction of teeth due to caries under general anaesthesia (GA) has been reported as increasing dramatically in England. The new UK government plans to transform NHS dentistry by improving oral health. Aim To evaluate the dental care received by children who required caries-related extractions under GA and obtain the views of their parents or guardians on their experiences of oral health services and the support they would like to improve their child's oral health, to inform future planning. Method An interview questionnaire was designed and piloted to collect data from a consecutive sample of 100 parents or guardians during their child's pre-operative assessment appointment. This took place at one London dental hospital between November 2009 and February 2010. Results Most children were either white (43%) or black British (41%); the average age was seven years (range 2-15, SD 3.1, SE 0.31) and the female:male ratio was 6:5. Most (84%) had experienced dental pain and 66% were referred by a general dental practitioner (GDP). A large proportion of parents or guardians (47%) reported previous dental treatment under GA in their children or child's sibling/s. Challenges discussed by parents in supporting their child's oral health included parenting skills, child behaviour, peer pressure, insufficient time, the dental system and no plans for continuing care for their child. Three out of four parents (74%) reported that they would like support for their child's oral health. Sixty percent of all parents supported school/nursery programmes and 55% supported an oral health programme during their pre-assessment clinic. Discussion These findings suggest that the oral health support received by high caries risk children is low. Health promotion programmes tailored to this cohort are necessary and our findings suggest that they would be welcomed by parents.

Oral Health Professional Alert on Special Care Dentistry

Introduction Despite overall improvements in oral health, the number of children admitted to hospital for extraction of teeth due to caries under general anaesthesia (GA) has been reported as increasing dramatically in England. The new UK government plans to transform NHS dentistry by improving oral health.Aim To evaluate the dental care received by children who required caries-related extractions under GA and obtain the views of their parents or guardians on their experiences of oral health services and the support they would like to improve their child's oral health, to inform future planning.Method An interview questionnaire was designed and piloted to collect data from a consecutive sample of 100 parents or guardians during their child's pre-operative assessment appointment. This took place at one London dental hospital between November 2009 and February 2010.Results Most children were either white (43%) or black British (41%); the average age was seven years (range 2-15, SD 3.1, SE 0.31) and the female:male ratio was 6:5. Most (84%) had experienced dental pain and 66% were referred by a general dental practitioner (GDP). A large proportion of parents or guardians (47%) reported previous dental treatment under GA in their children or child's sibling/s. Challenges discussed by parents in supporting their child's oral health included parenting skills, child behaviour, peer pressure, insufficient time, the dental system and no plans for continuing care for their child. Three out of four parents (74%) reported that they would like support for their child's oral health. Sixty percent of all parents supported school/nursery programmes and 55% supported an oral health programme during their pre-assessment clinic.Discussion These findings suggest that the oral health support received by high caries risk children is low. Health promotion programmes tailored to this cohort are necessary and our findings suggest that they would be welcomed by parents.

Background- Pre-school child health has always been one of the most important milestones for lifelong health research. Also, the knowledge and behaviour of the parents, especially mothers, affects children's health. The variable household-related factors and mothers, in particular, are considered to be the main role models that can improve pre-school children behaviour. Objective To determine the knowledge and behaviours of the mothers and their impact on pre-school 4-6 years old children oral health status. Method A 27 subjects’ questionnaire was prepared using previous questionnaires assessing mothers’ knowledge and behaviours towards oral health. Children's oral and dental health was examined by the researcher and scores were calculated using dmft (decayed, missing, filled, tooth) index. Accordingly, the effect of knowledge and behaviour of the mothers on their children dmft score was analysed. Chi-Square and logistic regression tests were used in the statistical analysis. Results The study population consisted of 261 pre-school children and their mothers. Which included 126 males (48.3%) males and 135 females (51.7%). The mean mothers’ oral health knowledge score was found to be 4.24  1.94. The children oral health examination through dmft scoring showed that 71.3% of children had experienced dental caries. the mean value for dmft score was 2.32  2.39. Our study showed that the mother's cumulative oral health knowledge score has a statistically significant relationship to the children oral health status. The higher the mother's oral health knowledge scores the lower their children dmft scores (p=0.001). Conclusion Mothers oral health knowledge and dental health indices in our study are lagging behind the developed countries and the WHO goal for the 21st century showing an urgent need to improve the effectiveness of preventive care in oral health programmes.

The authors describe the impact of the Title VII, Section 747 Training in Primary Care Medicine and Dentistry (Title VII) grant program on the development, growth, and expansion of general and pediatric dentistry residency programs in the United States. They first briefly review the legislative history of the Title VII program as it pertains to dental education, followed by a historical overview of dental education in the United States, including a description of the differences between dental and medical education and the routes to professional practice. The authors then present an extensive assessment of the role of the Title VII grant program in building general and pediatric dental training capacity, diversifying the dental workforce, providing outreach and service to underserved and vulnerable populations, stimulating innovations in dental education, and engaging collaborative and interdisciplinary training with medicine. Finally, the authors call for broadening the scope of the Title VII program to allow for predoctoral training (dental student education) and faculty development in general and pediatric dentistry. In doing so, the Title VII program can more effectively address current and future challenges in dental education, dentist workforce, and disparities in oral health and access to care.This article is part of a theme issue of Academic Medicine on the Title VII health professions training programs.

Background. Oral health and oral health care should be an integral part of the standard health care provision for care dependent individuals. Nevertheless, it is often neglected when confronted with limited time for daily hygiene care by caregivers, and it is experienced as difficult, intimate, and sometimes even shameful for both the caregiver and the care dependent person. Previous research revealed that nurses had poor knowledge, skills and attitudes towards oral health. Recently, training programmes in oral health care are being developed for care-organisations and international research is exploring the curriculum of caregivers. This research showed half of the respondents being aware of the relation between oral and general health and did not see the need to incorporate oral health care in the curriculum.&#x0D; Aim. The aim of this study is to gain insight into the extent of oral health care education in the curriculum that is necessary and feasible to make nurses competent to provide good oral health care for dependent persons. This will be translated into learning objectives that can be implemented in the curriculum of nurses.&#x0D; Method. First, to map the proportion of oral health care in the Flemish curricula for nurses, all European Credit Transfer System files (ECTS fiches) were evaluated. In addition, a survey was sent to teachers and curriculum coordinators to ask about the extent of oral health education in their program. Second, a Delphi study will be set up to build a consensus about the relevant oral health topics for nurses. The Delphi study consists of 3 rounds and an additional round with focus groups. Three target groups will be asked to participate: (1) oral health professionals, (2) teachers of the curriculum for nurses, and (3) nurses already employed in the field. A fourth round will discuss the ambivalent topics within and between target groups using several focus groups of important stakeholders.&#x0D; Results. ECTS files of the academic year 2019-2020 were used in the analysis. About half of the organisations who offered a 4-year nursing bachelor mentioned oral health care related topics in their ECTS fiches. The organisations spent a little over 2 hours on oral health care theory and 1.5 hours of practical oral health care training during the 4-year bachelor training or in the school. Lack of time, difficulty of the subject and low relevance were the most important mentioned barriers. A practical training was mentioned about the performance of oral care during their internship. The Delphi study will be carried out between November 2022 and June 2023. Preliminary results will be discussed during the ICIC conference.&#x0D; Discussion. Even though oral health care is an essential part of the daily care for patients, oral health care is seen as not so relevant and it is only minimally covered in their curriculum. With the reported barriers in mind, reaching a consensus between oral health professionals and caregivers is crucial for the introduction of oral health care learning objectives in the curriculum for nursing degrees.

Mobile health applications for children's oral health improvement: A systematic review

Elementary school children possess a high risk of dental caries. Based on the Basic Health Research 2018 data, the percentage of dental and oral health problems in the 10–14 year age group is 41.4%. Efforts to reduce dental and oral health problems in children are conducted by health promotion which can be implemented with flipchart media. Flipchart media can be an alternative; hence, elementary school children are able to better understand the importance of knowledge on maintaining oral health. The objective of this study is to determine the effect of promotion with flipcharts on the level of toothbrush knowledge of maintaining oral and dental health in children. This type of research was a quasi-experimental with a pretest-posttest design with control group. The research location is at SD Muhammadiyah Banyuraden, Gamping, Sleman, Yogyakarta. The research sample is 80 children aged 8 to 12 years. The sampling technique employed purposive sampling. The influence variable is promotion with flipchart, and the affected variable is the level of knowledge in maintaining oral health. The treatment and control groups performed pretest and posttest to determine the level of knowledge of dental and oral care in elementary school children. The results of the Wilcoxon Signed Rank Test analysis demonstrated that before and after promotion, the two groups owned a significant difference in toothbrush knowledge level (p=0.00). The results of the Mann Whitney test analysis display that the mean rank of children's toothbrush knowledge level using flipchart media is greater than PowerPoint media, which is 58.03&gt; 20.98 so that it can be stated that the use of flipchart media is more effective than PowerPoint media. The conclusion of the study is that promotion by employing flipchart media can increase the level of toothbrush knowledge on maintaining oral and dental health in children.