Abstract
Children in dentistry are traditionally described in terms of medical diagnosis and prevalence of oral disease. This approach gives little information regarding a child’s capacity to maintain oral health or regarding the social determinants of oral health. The biopsychosocial approach, embodied in the International Classification of Functioning, Disability and Health - Child and Youth version (ICF-CY) (WHO), provides a wider picture of a child’s real-life experience, but practical tools for the application of this model are lacking. This article describes the preliminary empirical study necessary for development of such a tool - an ICF-CY Core Set for Oral Health. An ICF-CY questionnaire was used to identify the medical, functional, social and environmental context of 218 children and adolescents referred to special care or paediatric dental services in France, Sweden, Argentina and Ireland (mean age 8 years ±3.6yrs). International Classification of Disease (ICD-10) diagnoses included disorders of the nervous system (26.1%), Down syndrome (22.0%), mental retardation (17.0%), autistic disorders (16.1%), and dental anxiety alone (11.0%). The most frequently impaired items in the ICF Body functions domain were ‘Intellectual functions’, ‘High-level cognitive functions’, and ‘Attention functions’. In the Activities and Participation domain, participation restriction was frequently reported for 25 items including ‘Handling stress’, ‘Caring for body parts’, ‘Looking after one’s health’ and ‘Speaking’. In the Environment domain, facilitating items included ‘Support of friends’, ‘Attitude of friends’ and ‘Support of immediate family’. One item was reported as an environmental barrier – ‘Societal attitudes’. The ICF-CY can be used to highlight common profiles of functioning, activities, participation and environment shared by children in relation to oral health, despite widely differing medical, social and geographical contexts. The results of this empirical study might be used to develop an ICF-CY Core Set for Oral Health - a holistic but practical tool for clinical and epidemiological use.
Highlights
Poor oral health is the commonest health problem in the world and as such, is a major public health issue and a major consumer of health spending [1]
The ICF-CY Checklist for Oral Health was completed by the investigator with help from the parent(s) in 97.2% (212) cases, using direct observation of the child in 90.4% (197) cases and using the medical and dental notes in 84.9% (185) cases
Poor and very poor health were significantly different between countries for physical, mental and oral health (x2 test)
Summary
Poor oral health is the commonest health problem in the world and as such, is a major public health issue and a major consumer of health spending [1]. Extreme inequalities in oral health exist in relation to functional capacity and disability, socioeconomic status and socio-political environment, both for adults and children [2,3,4,5,6,7,8,9,10]. Studies describe poor oral health in young populations with medical, social or psychological problems but these populations are ill-defined and difficult to identify and target. Many reports describe their study population solely in terms of medical diagnosis, but this gives very little information as to the capacity of the child to maintain oral health, within his or her socio-environmental context [11]. Other studies concentrate on quantifying disease prevalence but this again gives little insight into the actual determinants of poor oral health [4]. In order to aid the shift towards a holistic, biopsychosocial point of view it is necessary to develop validated tools to describe a child’s functional experience, ability to participate and the environmental context in which he or she lives [14,15,16,17]
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