Oral Health Service Planning Research Articles

Dental public health education in Egypt: a cross-sectional survey

Background and aimDental Public Health (DPH) education prepares future workforce to promote positive oral health behaviors, prevent oral diseases, and monitor disease distribution and trends taking into considerations best practices, needs and available resources. Scarce information is available about dental education in African countries and Egypt has the greatest number of dental schools in Africa. This study assessed the undergraduate DPH education in Egyptian universities including topics taught, methods of teaching, assessment, and the academics’ specialties.MethodsA survey targeted 43 Egyptian universities with Bachelor of Dentistry (BDS) programs identified on the website of the Supreme Council of Egyptian Universities in 2022. Thirty-six deans could be reached by post and/ or email. The survey appraised the school profile and capacity, and methods of teaching and assessment in DPH courses in undergraduate dental programs. The survey also inquired who taught DPH courses and what was covered in the courses. Descriptive statistics were displayed.ResultsWe received 21 (58.3%) responses from 36 deans/ senior officials. Of the universities, 52.4% were private and 47.6% were public. Most participants reported that DPH courses in BDS programs were taught by Pediatric Dentistry academics (71.4%) and DPH academics (57.1%) in 3rd, 4th and 5th years of the 5-year BDS programs. Teaching DPH consisted of face-to-face lectures (100%) and seminars (95.2%) and assessment included written exams with close ended questions (95.2%) and open-ended questions (71.4%). Twenty schools reported teaching the definition of DPH, definition of oral health, and determinants of oral diseases. Nine schools addressed the planning of oral health services and five schools taught about remuneration and payment systems.ConclusionTeaching and assessment of DPH in Egyptian dental schools use traditional methods with limited active engagement of the students. Variations among the schools exist in the DPH topics covered and most instructors were not primarily specialized in DPH. Development of dental/ oral health services calls for more emphasis on DPH education in the curriculum in Egypt.

Psychometric evaluation of the child oral impacts on daily performances (C-OIDP) for use in Turkish primary school children: a cross sectional validation study

BackgroundAs patient-reported outcome, the Child Oral Impacts on Daily Performances (C-OIDP) has been commonly used for assessing children’s oral health needs in order to facilitate oral health service planning. It was translated and cross-culturally adapted into Turkish in 2008. Since then, there is no study to assess its psychometric properties in Turkish child population. This cross–sectional study aimed to investigate the psychometric properties and factor structure of the Turkish version of the C-OIDP for use in Turkish primary school children.MethodsThe Turkish translated version was tested on a convenience sample of primary school children aged 11 to 12 years attending two public schools in Istanbul. Data were collected by clinical examinations, face-to-face interviews and self-completed questionnaires. The internal consistency, test–retest reliability, construct validity using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), criterion related validity (concurrent and discriminant) were evaluated.ResultsA total of 208 children were subjected to the tested the C-OIDP. Overall, 93.7% of them reported at least one oral impact in the last 3 months. The most frequently affected performances were “eating” (72.1%) and “cleaning mouth”, while the performance with the lowest impact was “studying” (13%). The internal consistency and reproducibility of the C-OIDP were acceptable, with a Cronbach’s alpha of 0.73 and an intra-class correlation coefficient of 0.83. The EFA yielded a two-factor model termed “functional limitation” and “psychosocial limitation”. CFA identified the two- factor model which fit the data better than the previously proposed three-factor model, namely physical, psychological and social health. Having malocclusion, the presence of gum disease, reported history of oral problems in the mouth, dissatisfaction with oral health, bad self-rated oral health and having a problem-oriented pattern of dental attendance were found to be the most important factors related to worse oral health- related quality of life, supporting its criterion–related validity.ConclusionThis study provided preliminary evidence the psychometric properties of the C-OIDP index among Turkish school children aged 11–12 years. It may be applied to evaluate the oral health impact on quality of life in this population.

Oral impact on daily performance (OIDP) scale for use in Sri Lankan adolescents: a cross sectional modification and validation study

BackgroundOral Health Related Quality of Life (OHRQoL) measures play an important role in understanding subjective patient experiences in oral health care. The Oral Impact on Daily Performance (OIDP) scale is a validated OHRQoL tool that measures the impact and extent to which an individual’s daily activities may be compromised by their oral health. It is commonly used to facilitate oral health service planning. The aim of this study was to modify and validate a Sinhalese version of the OIDP for use in Sri Lankan adolescents.MethodsStage I involved cultural adaptation of the tool through translation and modification. Stage II involved the exploring factor structure, validation and a reliability assessment. After translation and cultural adaptation, stage II was conducted among 220 secondary school students aged 15–19 in the Gampaha district, Sri Lanka. Participants completed the modified OIDP scale along with questions on self-reported perceived oral health problems and treatment need which were used to assesses the concurrent validity of the modified OIDP scale. Factorability was assessed by inspection of correlation matrix and Kaiser-Meyer-Olkin and Bartlett’s Test of Sphericity tests as a measure of sampling adequacy. An exploratory factor analysis was carried out using Principal Component Analysis method and factors were rotated using the oblimin method.ResultsThe Kaiser-Meyer-Olkin measure was 0.87 and Bartlett’s test of Sphericity was significant (p < 0.001) Cronbach’s alpha was calculated as 0.88, indicating a high level of internal consistency of the modified OIDP scale. The principal component analysis produced two factors with Eigen values ranging from 1.12 to 4.40, explaining 70.0% of total variance. Concurrent validity was satisfactory as the OIDP score increased when the adolescents’ perceived oral health decreased. The final modified OIDP consists of eight self-reported items which assesses the impact severity of eight daily performances over past three months. Participant scores ranged from 0 to 24 out of a worst possible score of 40, and nearly 48% of the responders reported at least one impact during past three months. The most prevalent oral health impact related to chewing and enjoying foods, reported by 36.8% of respondents.ConclusionThis study suggests that the modified OIDP scale has promising psychometric properties and is appropriate for use among adolescents in Sri Lanka. Further research is required to test the validity of this tool in other cohorts.

Edentulismo, uso de prótese e autopercepção de saúde bucal entre idosos

Objetivo O objetivo deste estudo foi verificar se a autopercepção de saúde bucal dos idosos apresenta coerência com a sua condição bucal, verificada a partir de exame de inspeção bucal, considerando perdas dentárias, uso e necessidade de próteses. Material e método Participaram 103 voluntários que frequentam o Centro de Referência de Idosos da Fundação Pró-Família de Blumenau-SC. Os dados foram coletados através de exame de inspeção bucal e aplicação do questionário que compõe o índice Geriatric Oral Health Assesment Index (GOHAI). Resultado Verificou-se maioria (83,5%) de mulheres entre os participantes, com média de idade de 70 anos. O edentulismo é alto, com 91,3% de usuários de prótese e 53,3% com necessidade de algum tipo de prótese. O valor médio do Índice de GOHAI, no grupo geral, foi 29,22, classificado como uma autopercepção de saúde bucal “ruim”. Entre os homens e os portadores de dentes naturais, a condição bucal foi considerada “regular”, com valores 31,3 e 31,7, respectivamente. Conclusão A autopercepção de saúde bucal pode ser considerada coerente com a precária condição bucal encontrada, marcada por alta prevalência de dentes perdidos. A reabilitação protética não contribuiu para a melhora da autopercepção de saúde bucal. Esses dados devem orientar o planejamento dos serviços de saúde bucal para a promoção de saúde e o autocuidado.

Do self-assessed oral health and treatment need associate with clinical findings? Results from the Finnish Nationwide Health 2000 Survey

Objective. To associate self-assessed oral health and treatment need with clinically determined findings. Materials and methods. As part of the Finnish nationwide comprehensive Health 2000 Survey, the present cross-sectional study included dentate participants aged 30–64 years who self-assessed their oral health and treatment need in an interview and who underwent a clinical oral health examination (n = 4385). Self-assessed oral health and treatment need were used as subjective indicators. Clinically determined dental and periodontal status described objective dental and periodontal health and treatment need. The evaluation of relationships between subjective and objective findings was based on two-by-two tables and multivariate analyses. Results. The better the self-assessed oral health, the better the objective dental and periodontal health. Those reporting need for treatment more often had the objective need in terms of dental or periodontal treatment, also when controlling for background factors. Of the subjective indicators, good self-assessed oral health best reflected the absence of clinically determined dental or periodontal treatment need. Those who reported a need for treatment were mainly adults with an objective dental and periodontal treatment need. Conclusions. Self-assessed good oral health is a fairly good estimate for the absence of clinically determined dental and periodontal treatment need. As implication for practice, self-assessed data could be used for screening purposes for oral health service planning and for priority allocation in large adult populations.

The experiences of dentists in the management planning of oral health services in Lesotho, Africa

Health sector reforms motivated by the need for efficiency, effectiveness and equity in the delivery of services have interested authorities in the planning competencies of managers, because planning sets the stage for the effective management of health systems. The huge public and private cost of oral health makes planning an important dimension for health authorities when considering the allocation of funds. Productivity in the oral health service sector is not often reported on, despite the cost involved in rendering oral health services. This study explores and describes the management planning experiences of oral health managers in the public sector in Lesotho, Africa, which consists of clinics in 10 districts serving hundreds of rural and remote mountainous communities. The study used a qualitative research design. Of the purposive sample of 14 public sector dentists then available, seven dentists (2 female and 5 male) met the criteria for participation (> or = 1 year of experience in district oral health planning), and consented to and were available for participation. Data were collected by in-depth, one-on-one interviews with 6 participants, and textual data were collected from the seventh. Interviews were audiotaped and transcribed verbatim. Data were organised and analysed using the Tesch method, with themed topics coded and categorised by a researcher and an independent coder for analysis. One major theme emerged (the management planning of oral health services were experienced as inefficient) and four sub-themes: (1) the need to plan carefully to provide efficient clinical services; (2) constraints to promoting expansion of community based dental services; (3) a breakdown in communication hampered service delivery; and (4) internal and external stakeholder issues impacted strongly on management planning. The inefficiency (failure of the community to derive maximum curative, preventive and rehabilitative benefits from public expenditure on oral health in Lesotho), as described by participants, arose from factors that impair careful planning; constrained the expansion of community based oral health services; caused a breakdown in communication between dentists and their authorities leading to poor services delivery; and was impacted strongly by internal and external stakeholder issues.

Dental caries in six, 12 and 15 year old Venda children in South Africa

Oral diseases is still a major problem in most developing countries. Within the Republic of South Africa, there remains areas where few or no studies have been done on the oral health status. The emerging district health system with decentralisation of health services to address past inequity in health care in South Africa also provides compelling case for data collection at regional levels. To assess the prevalence and severity of dental caries of school children; determine the caries patterns of the study population and to provide useful data for the planning of oral health services in this region. Descriptive analytical study. School children in the Donald Fraser Health District, Venda in the Northern province, Republic of South Africa. A total of 519 school children in the age groups 6, 12 and 15 years were examined by a calibrated examiner for dental caries using WHO diagnostic criteria. Both the schools, which were divided into rural and peri-urban locations and the children that participated were randomly selected. A mean dmft(sd) of 2.68(3.29) in six year olds and a mean DMFT (sd) scores of 0.61(1.50) and 1.26 (2.18) were recorded in the 12 and 15 year olds respectively. In the six year olds the upper anterior teeth showed highest susceptibility to caries, clearly indicating that black children suffer from early infant caries. At ages of 12 and 15 the mandibular molars were the teeth most affected. The decayed component constituted the main part of the dmft and DMFT scores. Ninety-nine percent of these lesions were untreated and the restorative care was almost nil. An important finding was the doubling of the mean DMFT from the 12-year-olds to 15-year olds and the caries levels for all age groups was higher than the provincial average. The treatment required were mostly extractions and simple fillings, the majority of which could be managed by dental auxiliaries using the Atraumatic Restorative Treatment Technique. This study indicates that preventive oral health measures should be implemented on the younger age groups in order to control dental caries.

A sociodental approach to assessing children's oral health needs: integrating an oral health-related quality of life (OHRQoL) measure into oral health service planning

We adopted a sociodental approach to assess the real dental needs of Thai primary school children, and integrated an oral health-related quality of life measure (OHRQoL) into oral health service planning. We then compared the results of this sociodental assessment with standard estimates of a child's oral health needs. We developed a new model of sociodental needs assessment and used it to assess the level of impact that various oral health conditions have on the everyday lives of school children. We then carried out a cross-sectional study of all grade-6 children (11-12 years old) in Suphan-buri Province, Thailand. We examined the sample (n = 1034) to assess the children's oral health and then we interviewed each child individually to assess what impact any dental conditions he or she may have on their quality of life. This assessment was done using an OHRQoL indicator, the Child Oral Impacts on Daily Performances index (child-OIDP). We integrated the results obtained using this indicator with those estimates obtained using more traditional, standard clinical methods, in order to generate a clearer picture of exactly which non-progressive dental conditions really needed treatment. These results take into account the impact those conditions have on the overall well-being of children and their ability to function normally and unimpeded. We were then able to prioritize their dental needs according to the severity of disruption caused in their daily lives. Using standard or "normative" estimates of dental health care needs, the children's need was 98.8%. This level of need decreased signifi cantly to 39.5% when adopting the sociodental approach (P <0.001). Overall, per 100 children with a standard or normative need for dental treatment, only 40 had a sociodental need for treatment when taking into account the impact their condition has on their everyday lives. Children thus identifi ed as requiring treatment were further categorized according to the severity of impact their condition had: 7.2% had severe, 10.3% moderate and 22.0% had minor impacts on OHRQoL. There was a marked difference between the standard normative and the sociodental needs assessment approach, with the latter approach showing a 60% lower assessment of dental health care needs in Thai 11-12-year-old children. Different levels of "impacts" on daily life can be used to prioritize children with needs.

Social and behavioural determinants of early childhood caries.

To investigate the association between selected social and behavioural (infant feeding and preventive dental practices) variables and the presence of early childhood caries in preschool children within the north Brisbane region. A cross sectional sample of 2515 children aged four to five years were examined in a preschool setting using prevalence (percentage with caries) and severity (dmft) indices. A self-administered questionnaire obtained information regarding selected social and behavioural variables. The data were modelled using multiple logistic regression analysis at the 5 per cent level of significance. The final explanatory model for caries presence in four to five year old children included the variables breast feeding from three to six months of age (OR=0.7, CI=0.5, 1.0), sleeping with the bottle (OR=1.9, CI=1.5, 2.4), sipping from the bottle (OR=1.6, CI=1.2, 2.0), ethnicity other than Caucasian (OR=1.9, CI=1.4, 2.5), annual family income dollars 20,000-dollars 35,000 (OR=1.7, CI=1.3, 2.3) and annual family income less than dollars 20,000 (OR=2.1, CI=1.5, 2.8). A statistical model for early childhood caries in preschool children within the north Brisbane region has been constructed using selected social and behavioural determinants. Epidemiological data can be used for improved public oral health service planning and resource allocation within the region.

Dental caries experience of preschool children from the North Brisbane region.

To report the dental caries experience of preschool children within the north Brisbane region and to investigate the association between selected social and demographic variables and disease presence. A cross-sectional sample of 2515 children aged four to six years was examined in a preschool setting using decayed, missing, filled teeth/surface (dmft/dmfs) and percentage caries free indices. A self-administered questionnaire obtained information regarding selected social and demographic variables. The data were analysed using the chi-square and one way analysis of variance procedures at the 5 per cent level of significance. Overall, 1668 (66.3 per cent) children were disease free at the examination and mean dmft was 1.4+/-2.77 and dmfs was 2.28+/-6.00. Dental caries occurred more frequently and severely in children from non-Caucasian background (p<0.000), family language other than English (p=0.001) and lower socio-economic status (p<0.000). Significant associations between child ethnicity, language spoken at home, socio-economic status and caries presence have been identified. Epidemiological data can be used for improved public oral health service planning and resource allocation within the region.

Welfare policy and planning of oral health services.

The Scandinavian countries are commonly referred to as welfare states, i.e. liberal states which assume responsibility for their citizens through a range of interventions in the market economy. The principles of the welfare policy are: 1) universality of population coverage, 2) comprehensiveness of risks covered, 3) adequacy of benefits and 4) citizens' right to health and social services. The goals are usually expressed in brief slogans like solidarity, universality, equality of opportunity, quality, efficiency and pluralism/"freedom of choice". Our welfare model is thus based upon ideals deriving from both individualistic and collectivistic philosophies, just as Scandinavia's mixed economy is. Similar to other health sectors, dental care is an integral part of the welfare state, striving to attain its manifold goals. Planning of oral health services should therefore be directed toward these goals, considering the shifts in the disease and problem panorama.

Forecasts of preserved teeth and denture wearers among Danish adults early in the next century.

To assist in the planning of oral health services, forecasts were made and goals specified with regard to the numbers of preserved teeth and subjects wearing full or partial dentures among Danish adults in 1992 and 2002. Forecasting was based on existing data, viz. a survey in 1982, including clinical examination, of a representative sample of 20-80-yr-olds (n = 2548), on register data from the National Health Insurance, and survival rates. By combining information from these sources, an increase was estimated in number of preserved teeth among 20-99-yr-olds from 68 million in 1982 to 82 and 92 million in 1992 and 2002, respectively. Correspondingly, a 28% increase in the mean number of remaining teeth was proposed as a goal for the year 2002. A decrease was estimated in the number of denture wearers, from 1.4 million in 1982 to 1.07 and 0.74 million in 1992 and 2002, respectively. The corresponding goal was specified as a 50% reduction in the proportion of denture wearers in 2002. In the middle aged and older part of the population the increasing number of remaining teeth may be expected to imply considerable needs for professional care even in the beginning of the next century.