Physicians' knowledge of and adherence to improving oral health

Gamification and Oral Health in Children and Adolescents: Scoping Review

BACKGROUND

Oral health is a determinant of overall well-being and quality of life. Individual behaviors, such as oral hygiene and dietary habits, play a central role in oral health. Motivation is a crucial factor in promoting behavior change, and gamification offers a means to boost health-related knowledge and encourage positive health behaviors.

OBJECTIVE

This study aims to evaluate the impact of gamification and its mechanisms on oral health care of children and adolescents.

METHODS

A systematic search covered multiple databases: PubMed/MEDLINE, PsycINFO, the Cochrane Library, ScienceDirect, and LILACS. Gray literature, conference proceedings, and WHOQOL internet resources were considered. Studies from January 2013 to December 2022 were included, except for PubMed/MEDLINE, which was searched until January 2023. A total of 15 studies were selected following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The eligibility criteria were peer-reviewed, full-text, and empirical research related to gamification in oral health care, reports of impact, and oral health care outcomes. The exclusion criteria encompassed duplicate articles; unavailable full texts; nonoriginal articles; and non-digital game-related, non-oral health-related, and protocol studies. Selected studies were scrutinized for gamification mechanisms and outcomes. Two main questions were raised: "Does gamification in oral health care impact oral health?" and "Does oral health care gamification enhance health promotion and literacy?" The PICO (Patient, Intervention, Comparison, Outcome) framework guided the scoping review.

RESULTS

Initially, 617 records were obtained from 5 databases and gray literature sources. After applying exclusion criteria, 15 records were selected. Sample size in the selected studies ranged from 34 to 190 children and adolescents. A substantial portion (11/15, 73%) of the studies discussed oral self-care apps supported by evidence-based oral health. The most clearly defined data in the apps were "brushing time" (11/11, 100%) and "daily amount brushing" (10/11, 91%). Most studies (11/15, 73%) mentioned oral health care behavior change techniques and included "prompt intention formation" (11/26, 42%), "providing instructions" (11/26, 42%), "providing information on the behavior-health link" (10/26, 38%), "providing information on consequences" (9/26, 35%), "modeling or demonstrating behavior" (9/26, 35%), "providing feedback on performance" (8/26, 31%), and "providing contingent rewards" (8/26, 31%). Furthermore, 80% (12/15) of the studies identified game design elements incorporating gamification features in oral hygiene applications. The most prevalent gamification features were "ideological incentives" (10/12, 83%) and "goals" (9/16, 56%), which were found in user-specific and challenge categories, respectively.

CONCLUSIONS

Gamification in oral health care shows potential as an innovative approach to promote positive health behaviors. Most studies reported evidence-based oral health and incorporated oral health care behavior change techniques.

Assessment of Pediatricians' and General Practitioners' Knowledge and Practice Regarding Oral Health, Dental Caries and Its Prevention in Children: A Cross-Sectional Study

OBJECTIVES

This study aimed to evaluate and compare the knowledge and practices of family physicians (general practitioners) and pediatricians concerning children's oral health.

MATERIALS AND METHODS

This research involved a cross-sectional survey with 446 respondents, consisting of 77.8% women and 22.1% men, with 81.6% being general (family) practitioners and 18.4% pediatricians. The survey comprised five sections, gathering information on participants' sociodemographic characteristics, routine oral cavity examination in clinical practice, knowledge about dental caries and its prevention, teething symptoms, and alternatives to fluorides for preventing dental caries.

RESULTS

The findings revealed an overall poor understanding of dental caries and its prevention, with an average score of 5.1 ± 1.6 out of a possible 10 points. Notably, practitioners with fewer pediatric patients during the workday, no training on oral health, and uncertainty about physicians' active role in oral health prevention exhibited lower knowledge levels (p ˂ 0.05). Over 90% of participants conducted dental and oral mucosal examinations on their patients. About 25% had received continuing education on children's oral health, and 70.6% expressed interest in further education on the subject.

CONCLUSIONS

This study highlights insufficient knowledge among physicians regarding dental caries and its prevention. With most participants eager to learn and actively promote children's oral health, providing training is essential to boost their knowledge and support children's oral health.

Tooth brushing practice in Ethiopia: a systematic review and meta-analysis

Oral hygiene refers to taking care and maintaining the cleanness of gum and teeth; a good oral hygiene practice promotes better oral health in general. Oral hygiene is the top public health concern of the population. Tooth brushing is a technique to keep oral hygiene from related complications. Therefore, this study provides the pooled prevalence of tooth brushing practice in Ethiopia. Databases searched for articles systematically across PubMed, Google Scholar, Hinari, EMBASE, and African Journals Online. Two reviewers independently conducted the selection, screening, reviewing, and data extraction using a Microsoft Excel spreadsheet and used the Joanna Briggs Institute prevalence critical appraisal tools to assess the quality of evidence. All studies conducted in Ethiopia from 2010 to 2020, reporting tooth-brushing practices extracted for and imported into the Comprehensive meta-analysis version 3.0 for further analysis. Beggs and Eggers's tests evaluated for publication bias with Higgins's method evaluated for heterogeneity. A random-effects meta-analysis model with a 95% confidence interval was computed to estimate the pooled effect size (prevalence). Furthermore, the authors employed subgroup analysis based on the study area and sample size. After reviewing 36, 10 articles fulfilled the inclusion criteria, and were included in the meta-analysis. The pooled prevalence of tooth brushing practice was 12.2% (95% CI 7.6-19.2%). The review reported a lower level of tooth-brushing practice in Ethiopia. We recommended that special attention should be given to the oral hygiene of the Ethiopian people.

Impact on Dental Utilization of the Integration of Oral Health in Pediatric Primary Care Through Quality Improvement

OBJECTIVES

To evaluate child-level dental utilization and expenditure outcomes based on if and where children received fluoride varnish (FV) at quality improvement (QI) medical practices, at non-QI medical practices, at dental practices, or those who never received FV from any practice.

DESIGN

Retrospective claims-based analysis cohort study.

SETTING

Children with Medicaid insurance through an Ohio pediatric accountable care organization.

PARTICIPANTS

Children aged 1 to 5 years with 1 or more well-child visits between 2015 and 2017.

INTERVENTION

FV receipt versus no FV. Among children who received FV, categorized if FV delivered by a QI-participating medical provider, a non-QI-participating medical provider, and a dental provider.

MAIN OUTCOME MEASURE

Dental claims from 2014 to 2019 were collected for preventive dental visits, caries-related treatment visits, dental general anesthesia (GA) visit, and emergency department visit for a dental problem to examine utilization patterns, expenditures, and dental outcomes.

RESULTS

The QI group had a significantly higher incidence of preventive dental visits than the dental (incidence rate ratio [IRR] = 0.93; 95% confidence interval [CI], 0.91-0.96) or non-QI groups (IRR = 0.86; 95% CI, 0.84-0.88). Compared with the QI group, the non-QI (adjusted odds ratio [aOR] = 2.6; 95% CI, 2.4-2.9) and dental (aOR = 2.9; 95% CI, 2.6-3.3) groups were significantly more likely to have caries-related treatment visits. The dental group children were significantly more likely to have dental treatment under GA than the QI group (aOR = 5.3; 95% CI, 2.0-14.4).

CONCLUSIONS

Children seen at QI practices appear to have an increased uptake of preventive dental services, which may explain the lower incidence of dental caries visits and GA treatment.

Dental Anxiety Among Physicians: Relationship with Oral Problems, Dental Visits, and Socio-Demographic Factors

Purpose

The purpose of study was to investigate dental anxiety (DA) and its relationship with oral health problems, dental visits, and socio-demographic factors among physicians.

Patients and Methods

This cross-sectional study was conducted on physicians working in Dhahran, Khobar, Dammam, and Qatif cities of the kingdom of Saudi Arabia. The study included physicians (general practitioners, residents, specialists, and consultants) working in the public and private sectors. Modified Dental Anxiety Scale and World Health Organization's Oral Health Questionnaire for Adults were used to evaluate DA, oral health problems, and dental attendance.

Results

The study included data from 355 participants with a mean age of 40.13 ± 10.45 years. There were 57.2% of non-Saudi and 42.8% of Saudi participants in the study. Bad dental experience in the previous dental visit was reported by 40% of participants, which was significantly related to DA (P = 0.002). Only 9.60% of participants had no DA, whereas 41.10% demonstrated low DA, 23.4% moderate DA, 18.9% high DA, and 7% extreme DA. Common oral problems included tooth sensitivity (65.40%), tooth cavities (45.90%), bleeding gums (43.10%), and bad breath (36.90%). More than half of participants (58.3%) visited the dentist during the last year and dental pain was the most common reason for dental visits (31.3%). Saudi participants demonstrated significantly increased DA than non-Saudis (P = 0.019). DA was significantly related to tooth sensitivity (P = 0.001), tooth cavities (P = 0.002), dry mouth (P = 0.044), and bad breath (P = 0.005). The participants with difficulty in biting foods (P > 0.001) and feeling embarrassed due to the appearance of teeth (P < 0.001) demonstrated significantly higher DA.

Conclusion

This sample of physicians showed a high prevalence of DA, oral problems, and dental visits due to pain. DA was significantly related to physicians' negative dental experience, tooth sensitivity, dental decay, dry mouth, and bad breath.

Evaluation of a special needs dental workshop for health professionals and students in Trinidad and Tobago

Aims

This study aimed to evaluate a special needs dental workshop for dentists, allied dental health professionals and students in Trinidad and Tobago.

Methods

This feedback study conducted in 2019-2020, included two surveys, one at the time of the workshop and a second survey one year after it. The first survey utilized an anonymous self-administered questionnaire enquiring about the reason for attendance, profession/education, demographics, and difficulties faced in treating patients with special needs. The follow-up study used an online survey tool assessing the workshop and queried comments/suggestions. The Chi-square test served for statistical analysis.

Results

Of the 176 attendees 131 participated (response: 74.4%). The majority (81.5%) were females. Most attendees were dental students (50.3%) or dentists (38.9%). Knowledge acquisition (73.1%) and professional development (14.2%) were the main motives for attendance while communication (31.8%) and non-compliance (34.5%) were the main problems faced in treating patients with special needs. The follow-up evaluation (post-workshop) (response: 72.5%) showed that most participants (90.5%) assessed the workshop as positive; 80% reported an increase in their knowledge and 64.2% perceived a need for further education.

Conclusion

These findings suggest a considerable demand for special needs dental services and continuing education and show that workshops can actively affect patient care.

Physicians' awareness of oral-systemic links and its association with physician-reported patient referral to dentists

INTRODUCTION

Physicians promote oral health by screening for oral pathologies, providing emergency help, and referring patients to dentists. The literature consistently reports a robust association between periodontal disease and systemic diseases. However, it is not fully known if physicians in Saudi Arabia are aware of the oral-systemic disease links. Therefore, the study aimed to evaluate physicians' awareness of the oral-systemic disease links and their association with patients' referral to dentists and patients' access to oral care.

METHODS

This cross-sectional study was conducted (June 2019-January 2020) on physicians working in private and public hospitals in the Eastern province of Saudi Arabia. The physicians (n = 333) responded to a paper-based self-administered and pilot-tested questionnaire which inquired about their awareness of oral-systemic disease links and patient referral to dentists. The reliability of items of oral-systemic disease links was evaluated by calculating Cronbach's alpha (0.84).

RESULTS

Most participants (92.8%) agreed/strongly agreed that oral health is associated with systemic health. Half of the sample (50.8%) referred patients to dentists during the last month. Almost 80.5% believed that more patients will be referred to the dentists because of their awareness of the oral-systemic disease links and 84% believed that more patients will access oral care services if patients were aware of the oral-systemic disease links. The participants who referred patients to the dentists during the last month (P = 0.038), believed that more patients will be referred (P = 0.001), and believed that more patients will access oral care (P = 0.003) demonstrated significantly higher oral-systemic disease links awareness score. The adjusted model showed patients' referral to dentist (OR = 1.96.10, P = 0.006) and believing in more patients accessing oral care (OR = 2.05, P = 0.044) were associated with significantly increased awareness of the oral-systemic disease links.

CONCLUSION

Most physicians in the study were aware of the oral-systemic disease links. Increased awareness of the oral-systemic disease links was significantly associated with the referral of patients to dentists and belief in improved patients' access to oral care services.

An Investigation of the Knowledge, Attitudes, and Practices of Physicians Regarding Child Oral Health at Primary Health Centers in Qatar: A Cross-Sectional Study

OBJECTIVES

 The aim of this study was to investigate physicians' knowledge, attitudes, and practices (KAP) in relation to oral health in children attending baby well clinics in primary health care centers (PHCC) in Qatar.

MATERIALS AND METHODS

 A cross-sectional design was adopted in which a piloted self-administered questionnaire was sent electronically to 417 physicians (pediatricians/family physicians) practicing in all PHCCs in Qatar. The questionnaire gathered information concerning demographic characteristics and KAP in relation to oral health in children. A score for each domain was given based on the percentage of correct answers.

STATISTICAL ANALYSIS

 Descriptive and analytical statistics were employed. For descriptive statistics, the frequency of distribution in relation to demographic data and responses to items of the questionnaire was presented. For analytical statistics, associations between independent variables (predictors) and KAP were assessed by employing univariate and multivariate logistic regressions. Predictors which were significantly associated in the unadjusted regression were entered into a final multivariate logistic regression to evaluate their effects after adjustment.

RESULTS

 The response rate was 24%. The overall mean scores of KAP were 61, 60, and 44.4%, respectively. Females were more likely to give positive answers than males (odds ratio [OR] = 12.3, 95% confidence interval [CI] 2.4-62.2, p = 0.02). Age groups 35 to 45 and >45 years had significantly more correct answers than <35 years age group (OR= 7.5, 95% CI = 1.1-56.6 and 9.2, 95% CI 1.2-44.6, respectively, p = 0.05). No significant associations were found between any of the independent variables with attitudes. With respect to practices, multivariate logistic regression revealed that specialty was significantly associated with practices. Pediatricians were more likely to adopt positive practices when compared with family medicine physicians (OR, 95% CI = 5.3 (1-25.6), p = 0.04).

CONCLUSION

 Although physicians demonstrated moderate levels of knowledge and attitudes, this did not reflect positively on their practices. The overall score of practices was considered poor (44.4%). Poor practices in our sample reflected an urgent need for actions and plans to improve this aspect and confirmed other findings which stated that acceptable levels of knowledge or attitudes do not necessarily translate into favorable practices.

Assessment of the professional dental cleaning knowledge, behavior and medical compliance among dentists, medical doctors and non-medical staffs: a cross sectional study in Chongqing, China

BACKGROUND

The professional dental cleaning (PDC) is an effective supplement that can make up for the lack of self-oral health care. Everyone should develop the habit of regular PDC. This study aimed to investigate the knowledge, behaviors and medical compliance of dentists, medical doctors and non-medical staffs about the PDC, identify the gaps, and provide information to help individuals develop healthy oral hygiene habit.

MATERIALS AND METHODS

A web-based survey with 21 questions designed based on the characteristics, the PDC knowledge, behaviors, and medical compliance of respondents. A cross-sectional study was conducted in the main districts of Chongqing, China, in the period of September-November 2020. A total of 456 respondents including 153 dentists, 137 medical doctors and 166 non-medical staffs in 3 communities and 4 hospitals were sampled online with multistage sampling and surveyed. The data was analyzed by chi-square test using IBM SPSS Statistics v. 21.0.

RESULTS

The cognitive level and behavior of dentists on the PDC was significantly better than that of medical doctors and non-medical staffs (p = 0.000-0.044). The rates of not knowing "dental plaque" were 32.85% and 61.45%, of the medical doctors and non-medical staffs. Meanwhile, most of them had misunderstanding about effects of the PDC. They thought it would whiten teeth (72.99%, 80.72%), damage gums (16.79%, 19.88%) and teeth (15.33%, 21.69%), and create bigger gaps between teeth (24.82%, 33.13%). In terms of gum health and the PDC behavior, significant differences were observed, 23.53% of dentists experienced irritated gum bleeding in the last 12 months, 42.28% did not have their teeth cleaned professionally in the last 12 months, even 7.84% never had it before. Compared with it, in the same situation, the ratios of medical doctors and non-medical staffs were about 60% experiencing irritated gum bleeding, 69.34% and 77.71% not experiencing the PDC in the last 12 months, up to 33.58% and 45.18% never experienced it before. 41 respondents (8.99%) disagreed with the reasonable and necessary medical behaviors before the PDC.

CONCLUSION

People's understanding about the PDC was insufficient, and many people, included some dentists, had not developed the habit of regular dental cleaning. Our study provided a new understanding of the PDC among dentists, medical doctors, and non-medical staffs, which may help to improve their awareness and behavior of oral hygiene health, and establish the multidisciplinary collaborations between dentists and medical doctors.

Leaky Gum: The Revisited Origin of Systemic Diseases

The oral cavity is the gateway for microorganisms into your body where they disseminate not only to the directly connected respiratory and digestive tracts but also to the many remote organs. Oral microbiota, travelling to the end of the intestine and circulating in our bodies through blood vessels, not only affect a gut microbiome profile but also lead to many systemic diseases. By gathering information accumulated from the era of focal infection theory to the age of revolution in microbiome research, we propose a pivotal role of “leaky gum”, as an analogy of “leaky gut”, to underscore the importance of the oral cavity in systemic health. The oral cavity has unique structures, the gingival sulcus (GS) and the junctional epithelium (JE) below the GS, which are rarely found anywhere else in our body. The JE is attached to the tooth enamel and cementum by hemidesmosome (HD), which is structurally weaker than desmosome and is, thus, vulnerable to microbial infiltration. In the GS, microbial biofilms can build up for life, unlike the biofilms on the skin and intestinal mucosa that fall off by the natural process. Thus, we emphasize that the GS and the JE are the weakest leaky point for microbes to invade the human body, making the leaky gum just as important as, or even more important than, the leaky gut.

Oral health-related interdisciplinary practices among healthcare professionals in Saudi Arabia: Does integrated care exist?

Background

There is a bidirectional relation between oral and general health, therefore collaboration between healthcare providers is needed. This study investigated current interdisciplinary practices (IDP) and the associated factors among healthcare professionals in Saudi Arabia.

Methods

A cross-sectional study was conducted in the Eastern Saudi Arabia recruiting four groups of health professionals (nurses, physicians, pediatricians and Ear-Nose and Throat (ENT) specialists). A validated, self-administered questionnaire was distributed online and shared through social media platforms. The questionnaire explored predisposing factors (demographics) and facilitating factors (knowledge, attitudes, attendance of oral health training and source of knowledge) associated with IDP.

Results

A total of 1398 health professionals were recruited. Participants showed fair oral health knowledge (7.1 ± 2.1) and attitudes (22.2 ± 3). Three-fourths (74.6%) reported always providing oral health education (OHE) to their patients, more than half (59.6%) reported always conducting an oral health screening (OHS), two-thirds (66.7%) reported responding to patients’ questions about oral health or conditions and 58.7% reported referring patients to dentists. Pediatricians and physicians had greater odds of IDP compared to other health professionals. Source of oral health knowledge (Ministry of Health (MOH) and formal education) was significantly associated with increased odds of IDP. Participants with good oral health knowledge had greater odds of responding to patients’ oral health question as well as have more referral practices.

Conclusion

The results reveal a discrepancy between participants' IDP, knowledge, and attitudes. Incorporating dental component to medical curricula, continuous education and training programs targeting health professionals through Ministry of Health should be considered.

Relationship between erosive tooth wear and possible etiological factors among dental students

OBJECTIVES

The aim of this study was to assess the relationship between erosive tooth wear (ETW) and possible etiological factors in a group of dental students.

MATERIALS AND METHODS

A total of 126 dental students from a public dental school were included in this study. A questionnaire was used to investigate the possible etiological factors related to ETW. The Basic Erosive Wear Examination (BEWE) criteria were used to examine the status of ETW. A univariable and multivariable logistic regression models were used to assess the relationship between the presence of ETW and explanatory variables.

RESULTS

Univariable analysis revealed that taking acidic foods and alcohol more than 4-5 times per week increases the odds of ETW by 6.043 and 2.532 times, respectively, and taking dairy products, fruit juice, and milk more than 4-5 times per week decreases the likelihood of ETW by 61%, 66%, and 80%, respectively. The results of multivariable regression analysis showed that the frequency of consumption of especially acidic foods significantly increased the risk of ETW (OR = 9.981, 95% CI 3.577-27.849, p < 0.001).

CONCLUSIONS

Although the ETW status of dental students, who are the future dentists, varies depending on different possible etiological factors, especially the consumption of acidic foods has increased the risk of ETW approximately 10 times.

CLINICAL RELEVANCE

The findings highlight the high relevance of ETW, especially with acidic food consumption, and the importance of controlling potential etiological factors in dental students.

Development of Valid and Reliable Tools for Pediatricians' Knowledge and Self-Perceived Competency Towards Oral Health of Children in Turkey

Background

This study aimed to develop a valid and reliable questionnaire of knowledge about oral health in childhood and a scale of self-perceived competency for pediatricians. In this way, the contributions of Turkish pediatricians on oral health in childhood and their effects on children's oral health and caregivers will be evaluated.

Subjects and Methods

Items were generated from published scientific literature, other questionnaires, and interviewing notes with the pedodontists. The study group examined publications on the preventive oral health of children, and they included items related to children in the item pool. The initial knowledge questionnaire consisted of 23 items and 10 items for the self-perceived competency scale. The content validity of the questionnaire and scale were determined by the assessments of the expert team. The internal consistency of the knowledge questionnaire and test-retest reliability of the self-perceived competency scale was examined.

Results

Thirty pediatricians took part in the study. The pediatricians were: 63.3% (n = 19) female and 36.7% (n = 11) male; their mean age was 37.97 ± 3.86 years. Most of the pediatricians were specialists with 83.4% (n = 25). The medical specialization of all pediatricians was university and the working year mean was 10.93 ± 4.28. The knowledge questionnaire had 10 items after content validity and internal consistency reliability investigations. The initial number of items for the self-perception level scale was 10. We excluded five items due to the content validity index. ICC value for 5-item self-perception level scale was calculated as 0.816 (95% CI: 0.606-0.914). Therefore, the scale has a good reliability level.

Conclusion

Our knowledge questionnaire and self-perceived competency scale provide a validated and reliable tool in the assessment of pediatricians' knowledge and competency regarding oral health. Pediatricians can test themselves using this knowledge questionnaire and self-perceived competency scale.

Designing and Evaluation of an Elective Oral Health Course for Fifth-Year Medical Students of Tehran University of Medical Sciences

Objectives: This study aimed to evaluate the effect of an educational intervention on oral health-related knowledge, attitude, and practice of medical students. Materials and Methods: This study was performed on the fifth-year medical students attending an elective oral health course at the Faculty of Dentistry of Tehran University (intervention group) and 25 other students attending another elective course (control group) in 2018. A 2-week internship program including 6 sessions of a workshop program plus 2 days of school field and 2 days of attending dental departments was designed for the intervention group. Before and after the intervention, students completed a questionnaire and their simplified debris index was calculated. Statistical analysis was performed using SPSS version 24 by paired-sample t-test and general linear regression. Results: The mean age of the participants was 24.84±1.31 years in the intervention group and 23.64±1.28 years in the control group. There were 14 (56%) males in the intervention group and 16 (64%) males in the control group. At baseline, the mean knowledge, attitude and practice scores of the control and intervention groups were 26.28, 14.20 and 10.88, and 27.84, 15.80, and 9.36, respectively. After the intervention, the knowledge, attitude, debris index and willingness to adhere to oral health measures significantly improved (P<0.05). Conclusion: Oral health-related knowledge, attitude and practice of medical students were not desirable at baseline. The present study showed that even a short-term intervention in this field was effective to improve the oral health concepts in this group.

The "Gum-Gut" Axis in Inflammatory Bowel Diseases: A Hypothesis-Driven Review of Associations and Advances

In modern medicine, the oral cavity has often been viewed as a passive conduit to the upper airways and gastrointestinal tract; however, its connection to the rest of the body has been increasingly explored over the last 40 years. For several diseases, the periodontium and gingiva are at the center of this oral-systemic link. Over 50 systemic conditions have been specifically associated with gingival and periodontal inflammation, including inflammatory bowel diseases (IBD), which have recently been elevated from simple "associations" to elegant, mechanistic investigations. IBD and periodontitis have been reported to impact each other's progression via a bidirectional relationship whereby chronic oral or intestinal inflammation can impact the other; however, the precise mechanisms for how this occurs remain unclear. Classically, the etiology of gingival inflammation (gingivitis) is oral microbial dysbiosis in the subgingival crevice that can lead to destructive periodontal disease (periodontitis); however, the current understanding of gingival involvement in IBD is that it may represent a separate disease entity from classical gingivitis, arising from mechanisms related to systemic inflammatory activation of niche-resident immune cells. Synthesizing available evidence, we hypothesize that once established, IBD can be driven by microbiomial and inflammatory changes originating specifically from the gingival niche through saliva, thereby worsening IBD outcomes and thus perpetuating a vicious cycle. In this review, we introduce the concept of the "gum-gut axis" as a framework for examining this reciprocal relationship between the periodontium and the gastrointestinal tract. To support and explore this gum-gut axis, we 1) provide a narrative review of historical studies reporting gingival and periodontal manifestations in IBD, 2) describe the current understanding and advances for the gum-gut axis, and 3) underscore the importance of collaborative treatment and research plans between oral and GI practitioners to benefit this patient population.

Perceptions of oral health education and practice among nursing students in Malaysia and Australia

OBJECTIVE

Representing the largest proportion of healthcare workers, nurses play a significant role in oral health (OH) maintenance as part of a larger effort to promote holistic patient care. The study aims to determine nursing students' perceptions of OH education and practice in Malaysian and Australian nursing schools.

MATERIALS AND METHODS

A self-administered questionnaire (content- and face-validated) survey was undertaken, classroom style, amongst final-year nursing students from selected Malaysian (n = 122, Response rate=97.6%) and Australian (n = 299, Response rate=54.7%) institutions. Quantitative data were analysed via Statistical Package for Social Science software (Chi-square and Fisher's exact tests, p ≤ 0.01).

RESULTS

Significantly more Malaysian nursing students, compared to those in Australia, reported having encountered patients with OH issues (98.4% vs. 82.9%), namely halitosis (87.7% vs. 62.2%), oral ulcers (63.1% vs. 41.1%), oral/dental trauma (36.9% vs. 21.1%) and caries in children (28.7% vs. 7.7%). Less than half of Malaysian and Australian nursing students reported that they received adequate OH training (48.4% vs. 36.6%, p ≤ 0.01), especially in detecting oral cancer (18.0.0% vs. 22.6%, p ≤ 0.01) and preventing oral diseases (46.7% vs. 41.7%, p ≤ 0.01). Students in both countries demonstrated positive attitudes and believed in their role in OH care. Most students agreed that they should receive training in OH, especially in smoking cessation and providing OH care for patients with special needs. They also opined that a standardized evidence-based oral hygiene protocol is needed.

CONCLUSION

Support for education and practice in this area of patient care suggested positive implications for further development of nurses' roles in OH promotion and management.

Knowledge of oral health among family medicine physicians in Riyadh, Saudi Arabia 2020

Background

Preventive oral health care (OHC) is an important part of preventive health care and needs to be started early in life. Family physicians are in a position where they can help to initiate preventive OHC. From previous literature, oral health has an impact on the general health and quality of life of individuals with a large burden on the health care system. In addition, pediatricians and family physicians lack knowledge in oral health and can be unwilling to participate in preventive OHC. We aim to increase family physicians' knowledge of oral health.

Objectives

This study aimed to measure the level of knowledge about oral health and identify some of its determinants among family physicians working in Riyadh, Saudi Arabia.

Methods

This is a cross-sectional study that included 187 family physicians to measure the knowledge of family doctors about oral health using a self-administered questionnaire.

Results

The total mean score was 119.28 ± 11.26 out of 175, indicating a poor level of knowledge level about oral health.

Conclusion

Family physicians in Riyadh, Saudi Arabia lack knowledge of oral health. These findings make it necessary to include oral health topics during residency and continuing medical education programs.

The Effects of Gamification and Oral Self-Care on Oral Hygiene in Children: Systematic Search in App Stores and Evaluation of Apps

Background

Poor oral hygiene is a great public health problem worldwide. Oral health care education is a public health priority as the maintenance of oral hygiene is integral to overall health. Maintaining optimal oral hygiene among children is challenging and can be supported by using relevant motivational approaches.

Objective

The primary aim of this study was to identify mobile smartphone apps that include gamification features focused on motivating children to learn, perform, and maintain optimal oral hygiene.

Methods

We searched six online app stores using four search terms (“oral hygiene game,” “oral hygiene gamification,” “oral hygiene brush game,” and “oral hygiene brush gamification”). We identified gamification features, identified whether apps were consistent with evidence-based dentistry, performed a quality appraisal with the Mobile App Rating Scale user version (uMARS), and quantified behavior scores (Behavior Change score, uMARS score, and Coventry, Aberdeen, and London-Refined [CALO-RE] score) using three different instruments that measure behavior change.

Results

Of 612 potentially relevant apps included in the analysis, 17 met the inclusion criteria. On average, apps included 6.87 (SD 4.18) out of 31 possible gamification features. The most frequently used gamification features were time pressure (16/17, 94%), virtual characters (14/17, 82%), and fantasy (13/17, 76%). The most common oral hygiene evidence-based recommendation was brushing time (2-3 minutes), which was identified in 94% (16/17) of apps. The overall mean uMARS score for app quality was high (4.30, SD 0.36), with good mean subjective quality (3.79, SD 0.71) and perceived impact (3.58, SD 0.44). Sufficient behavior change techniques based on three taxonomies were detected in each app.

Conclusions

The majority of the analyzed oral hygiene apps included gamification features and behavior change techniques to perform and maintain oral hygiene in children. Overall, the apps contained some educational content consistent with evidence-based dentistry and high-quality background for oral self-care in children; however, there is scope for improvement.

Working collaboratively across schools to promote oral health education through interprofessional education

PURPOSE

The Association of American Medical Colleges and American Dental Education Association have identified oral health knowledge, skills, and attitudes shared by both medical and dental professionals. Although oral health was deemed an essential competency for medical practitioners, our state struggled to ensure learners received proper training. This training deficit resulted in conducting a needs assessment and implementing an oral health interprofessional module at our schools.

METHODS

First-year medical students and clinical faculty were emailed surveys in 2016 to obtain baseline information. A team of faculty and students from the Schools of Medicine and Dentistry reviewed the curriculum to determine where to augment oral health content. An oral health module to teach a basic head, neck, and oral examination to first-year medical students during their patient-centered care small-group sessions was implemented and evaluated.

RESULTS

Only 13.6% of faculty respondents were aware of national oral health competency recommendations, and <50% rated oral health important for primary care physicians (PCPs) to include in history, physical exam, or oral health counseling. On baseline, ≤25% of PCP respondents reported integrating the listed skills in their practice, and most indicated lacking expertise to teach oral health. Teaching sessions were rated helpful by students and faculty. After the teaching sessions, ratings on the importance of including oral health significantly increased from baseline.

CONCLUSION

Collaboration between Schools of Dentistry and Medicine successfully integrated oral health into medical school curriculum and improved the tutors' attitudes of its importance.

Should dentistry be a specialty of medicine? Two viewpoints

Dentistry and dental education are well-established domains with deep-rooted institutions, educational programs, organizational structures, and advanced specialty fields. Almost 100 years ago, Dr. William Gies, founder of the Columbia University College of Dental Medicine, stated that to best serve the oral health needs of the population, dentistry should be considered a specialty of medicine, and dental students should have the same solid foundation in the basic and clinical sciences as medical students. More recently, the report on "Advancing Dental Education in the 21st Century" recommends an increase in the integration of dental and medical education as a means to address 2 of its key challenges: "shrinking demand for dental services" and "shifting practice environment." However, it has also been argued that making dentistry and dental education a subspecialty of medicine and medical education will create logistical, structural, regulatory, and financial dilemmas. Instead of a drastic change to current dental educational, organizational, and institutional models, some argue a contemporary approach to dental education is required to ensure dentists are well prepared to address the healthcare needs of the population and future healthcare delivery systems and practice models. Recognizing the need for change in dental education to keep pace with changes in patient demographics and healthcare systems, the dental profession has the responsibility and opportunity to develop new models and paradigms that improve educational and clinical outcomes in our educational programs and future practice.

Health Professionals Oral Health Knowledge and Practice: Unleashing the Hidden Challenges

Objective

Dental disease is one of the major prevalent preventable public health challenges that resulted in a significant burden on children and adults. The aim of the current study was to identify oral health-related knowledge and practice among Bahir Dar community health care providers and the perceived barriers to oral health care services.

Methods

A cross-sectional study was conducted. A self-administered, structured questionnaire was used for data collection, and SPSS version 20 was used for data analysis. A chi-square test was used to determine the association between study variables, and a P-value of less than 0.05 was considered to declare statistical significance.

Results

A total of 281 interviews were conducted. Doctors had the highest mean knowledge score value of 4.67 followed by dentists with a mean score of 4.5. The majority of the study participants (59.4%) reported that they use a toothbrush and fluoride toothpaste for brushing their teeth, and a statistically significant difference was observed between different types of health professionals. The majority of the study participants (80.1 and 70.8%) reported limited finances and lack of adequate health/dental insurance as a barrier to oral health care services, respectively.

Conclusion

Oral health-related knowledge of health professionals in Bahir Dar city is low. Oral health topics must be incorporated into the health care professionals training programs and continuing medical education. Health professionals should master basic oral health-related knowledge, and they should practice basic oral health care practices to become role models for their patients.

Knowledge of and attitudes towards erosive tooth wear among students of two Chinese universities

Background

To assess the knowledge of and attitudes towards erosive tooth wear among dental, medical, and non-medical university students of two Chinese universities.

Methods

A questionnaire containing 15 questions on knowledge of erosive tooth wear and 10 questions on attitudes towards erosive tooth wear was designed, and its psychometric properties (reliability and validity) were analysed in a pilot study (n = 120 students). The following 3 groups of university students (n = 635) were recruited based on a convenience sampling technique and were distributed the questionnaire via an online survey system: dental students (DSs), medical students (MSs), and non-medical students (NSs). Differences in the scores between groups and genders were analysed by one-way analysis of variance (ANOVA). The Pearson correlation coefficient was used to determine the association between the knowledge and attitude scores (P < 0.05).

Results

The questionnaire was found to be reliable, valid and reproducible. A total of 435 students participated in this study (response rate: 69.6%). The knowledge score of the DSs (11.5 ± 3.4) was significantly higher than those of the NSs (5.5 ± 4.0) and MSs (6.1 ± 4.0) (P < 0.001). The attitude score of the DSs (45.2 ± 6.5) was significantly higher than those of the NSs (41.1 ± 6.9) and MSs (41.8 ± 6.4) (P < 0.001). The majority of DSs expressed attitudes that were more accurate and positive than those expressed by the other 2 groups. The attitude score was positively correlated with the knowledge score (r = 0.237, P < 0.001).

Conclusions

Dental students had more accurate knowledge of and more positive attitudes towards erosive tooth wear than medical and non-medical students. In this population, a positive correlation was established between knowledge of and attitudes towards erosive tooth wear.

Oral Health Awareness among International Dental and Medical Students at Lithuanian University of Health Sciences: a Cross-Sectional Study

Objectives

To evaluate the self-reported oral health awareness, knowledge and attitude among international dental and medical students at the Lithuanian University of Health Sciences (Kaunas, Lithuania).

Material and Methods

A cross-sectional study was conducted among international medical and dental students at the Lithuanian University of Health Sciences in 2016 - 2017. The students were invited to participate in the survey before the beginning of a lecture, and they were informed that participation was voluntary and anonymous. In total, 282 students participated in the study, with a response rate of 92.1%. A self-administered English questionnaire consisting of 25 items with options on a Likert scale (agree, neither agree nor disagree and disagree) about oral health problems and their relation to general health status was used to assess a student’s oral health awareness, attitude and knowledge. The level of significance was set at P < 0.05.

Results

Overall good, fair and poor oral health awareness was reported by 71.3%, 24.1% and 4.6%, respectively, of the international dental and medical students (P < 0.05). The mean score of oral health awareness was 18.2 (standard deviation [SD 3.27]), showing overall good oral health awareness. Moreover, the international dental students reported higher oral health awareness than medical students (19.14 [SD 3.25] vs 17.44 [SD 3.1]) (P < 0.001). Comparing this mean score by gender, no statistically significant difference was found (18.33 [SD 3.39] vs 18.05 [SD 3.16]) (P = 0.371).

Conclusions

Overall oral health awareness among international dental and medical students was high. Meanwhile, international dental students reported higher oral health awareness than international medical students.

Effectiveness of smart phone application use as continuing medical education method in pediatric oral health care: a randomized trial

BACKGROUND

Continuing education aims at assisting physicians to maintain competency and expose them to emerging issues in their field. Over the last decade, approaches to the delivery of educational content have changed dramatically as medical education at all levels is now benefitting from the use of web-based content and applications for mobile devices. The aim of the present study is to investigate through a randomized trial the effectiveness of a smart phone application to increase public health service physicians' (PHS physicians) knowledge regarding pediatric oral health care.

METHOD

Five of all seven DHCs (District Health Center) in Tehran, which were under the supervision of Tehran University of Medical Sciences and Iran University of Medical Sciences, were selected for our study. Physicians of one DHC had participated in a pilot study. All PHS physicians in the other four centers were invited to the current study on a voluntary basis (n = 107). They completed a self-administered questionnaire regarding their knowledge, attitudes, practice in pediatric dentistry, and background. PHS physicians were assigned randomly to intervention and control groups; those in the intervention group, received a newly designed evidence-based smartphone application, and those in the control group received a booklet, a CME seminar, and a pamphlet. A post-intervention survey was administered 4 months later and t-test and repeated measures ANCOVA (Analysis of Covariance) were performed to measure the difference in the PHS physicians' knowledge, attitude and practice.

RESULTS

In both groups, the mean knowledge scores were significantly higher (p-Value < 0.001) in post-intervention data compared to those at baseline. Similar results existed in attitude and practice scores. Although the scores in knowledge in the intervention group indicating potentially greater improvement when compared to those of the control group, the differences between the two groups were not statistically significant (dif: 0.84, 95% CI - 0.35 to 2.02).

CONCLUSION

In the light of the limitations of the present study, smart phone applications could improve knowledge, attitude and practice in physicians although this method was not superior to the conventional method of CME.

TRIAL REGISTRATION

Our clinical trial had been registered in Iranian Registry of Clinical Trials (registration code: IRCT2016091029765N1).

Implementing Pediatric Fluoride Varnish Application in a Rural Primary Care Medical Office: A Feasibility Study

INTRODUCTION

The objective of this study was to determine if the application of fluoride varnish (FV) to children 5 years and under was acceptable and practical for health care providers in a rural primary care office.

METHODS

We employed a quasi-experimental study design comprised of providers who received education and training in FV application. Pre- and post-study surveys regarding barriers and facilitators were administered. Data was collected on the number of FV applications, time spent on procedure, perceived barriers, and overall cost.

RESULTS

The total direct variable cost of providing FV was $4.35 per procedure, resulting in an $11.85 profit. FV application increased 9.57%. Potential barriers were lack of proper supplies, lack of adequate support staff, and lack of additional financial compensation for providers.

DISCUSSION

FV application is a service that can be delivered in a rural practice with existing resources, but the initiative needs support from practice management.

Medical, Dental, and Nursing Students' Knowledge about Early Childhood Oral Health Care

Gaps in knowledge of physicians and nurses about early childhood oral health care were reported and are likely due to the poorly focused education on oral health issues; therefore, the purpose of this study was to assess the knowledge level of Qassim University medical, dental and nursing students about early childhood oral health care and its relation to demographic variables, students’ perceived knowledge, satisfaction with their knowledge and interest in further education about the topic. A total of 571 medical, dental, and nursing students received a questionnaire that included demographic questions, questions to assess knowledge level of the students about early childhood oral health care, and questions to assess their perceived knowledge level, satisfaction with their knowledge and interest in further education about the topic. Results of the study revealed that knowledge of dental students was highest (score 7.72 out of 10) followed by nursing students (4.79), and medical students (4.43). Additionally, students with a higher level of perceived knowledge were more likely to score higher. In view of the inadequate knowledge level of medical and nursing students about early childhood oral health care when compared to dental students, improvements in medical and nursing education programs are necessary at Qassim University.

Awareness of the Relationship between Systemic and Periodontal Diseases among Physicians and Dentists in Saudi Arabia and Kuwait: Cross-sectional Study

Background:

Previous studies have shown possible association between periodontal diseases and Diabetes Mellitus (DM), Cardiovascular Disease (CVD) and Adverse Pregnancy Outcomes (APO). Increasing the knowledge of physicians and dentists regarding the association between periodontal disease and systemic diseases should improve their ability to provide a high standard of treatment for the disease and prevent its consequences. In our study, we sought to identify knowledge gaps in the awareness of the relationship between systemic and periodontal diseases among dentists and physicians from the Kingdom of Saudi Arabia and the State of Kuwait.

Methods:

A cross-sectional study was performed with a convenient sample of selected physicians and dentists in Saudi Arabia and Kuwait using a self-developed structured questionnaire. Physicians’ and dentists’ awareness were assessed regarding current evidence of the relationship between systemic diseases and conditions (DM, CVD, APO) and periodontal diseases.

Results:

A total of 134 (21.5%) of the identified physicians and 485 (78%) of the identified dentists participated in this study. More than half of the participants (52.1% physicians and 67.5% dentists) agreed that there is a relationship between periodontal diseases and DM, CVD and APO. Dentists had a statistically higher level of awareness compared with the physicians. The findings related to the awareness of the dentist sub groups highlighted that periodontists were significantly more likely to have a good level of knowledge.

Conclusion:

Within the limitations of this study, we concluded that the awareness of physicians and dentists regarding the relationship between periodontal diseases and systemic diseases (DM, CVD, APO) is generally low, Therefore, improved collaboration between medical and dental health providers is recommended.

Bisphosphonate-Related Osteonecrosis of the Jaw: An Enigma among Medical Practitioners

Context: Owing to the increasing number of cancer cases, and introduction of newer drugs like bisphosphonates (BP) for the management of metastatic bone disease, complications such as bisphosphonate-related osteonecrosis of the jaw (BRONJ) have come into light. However, several of the treating physicians are not fully aware of this adverse effect. Aim: This study aimed to assess the knowledge and awareness of physicians regarding BRONJ and practices related to bisphosphonate use. Settings and Design: A cross-sectional study conducted among health-care professionals in various medical institutions in Mangalore. Subjects and Methods: A questionnaire was developed to assess the knowledge and awareness of physicians about osteonecrosis of the jaw and practices related to bisphosphonate use, consisting of 21 questions, 12 – knowledge based and 9 – practice based. The questionnaire was validated and distributed among 113 doctors; their responses assigned scores, tabulated and assessed. Statistical Analysis: One-way analysis of variance and Tukey test. Results: More than 50% of the medical professionals had a score <40%, which shows a lack of knowledge about BP and BRONJ. About 45% of the medical professionals in the study group failed to identify the clinical features of BRONJ, and 67.26% were unaware of the risk associated with tooth extractions and oral surgical procedures in the development of the condition. Conclusion: Bisphosphonate-related osteonecrosis is almost exclusively seen in the jaws and hence, the diagnosis usually made by a dental practitioner. Lack of awareness of jaw osteonecrosis among the medical practitioners can result in delay in providing the right treatment.

Family physicians' knowledge and awareness regarding oral health: A survey

INTRODUCTION

Oral health is an important component of general health. The World Health Organization has highly recommended the integration of oral health promotion into general health care. In majority of the cases, patients visit their physicians with simultaneous oral and systemic complaints, and primary oral complaints are more frequently encountered. Therefore, primary care physicians can play an expanded role within oral health care to raise the overall health of the patients.

AIM

This study aimed to assess the knowledge and awareness of family physicians regarding oral health.

MATERIALS AND METHODS

An observational (cross-sectional) study was conducted among 250 family physicians who are practicing in Tricity. A self-structured questionnaire (close-ended) prepared by a panel of oral health experts in English language (close-ended) was administered to the study participants. The questionnaire which was divided into two parts, A and B, contained 15 questions on knowledge and awareness regarding oral health. Categorization of knowledge scores was done at three levels: low, medium, and high. Statistical analysis was performed using analysis of variance and Student's t-test.

RESULTS

Males comprised 72.8% (182) of the study population and 55.2% (138) of the participants were doing combined practice (academic and private both). Low knowledge scores were reported in 47.2% (118) of the participants whereas only 22.4% (56) of participants had a high score. The mean knowledge score according to educational level and working profile was statistically significant (P < 0.05).

CONCLUSION

The results of our study showed a considerable lack of knowledge among family physicians regarding connection of oral health with general health. Therefore, there is an urgent need to increase their knowledge by various continued medical education and training programs.

Assessment of the oral health behavior, knowledge and status among dental and medical undergraduate students: a cross-sectional study

Background

It is widely accepted that oral health plays an important role in overall health. Both dental and medical students are expected to possess good oral health awareness and work together for public oral health promotion especially in developing countries like China. The aim of this study was to assess the oral health knowledge, behavior and status of dental and medical undergraduate students in the first (fresh) and third year (before specialized courses) study.

Methods

A self-administered structured questionnaire with 13 questions was designed based on oral health knowledge, behavior and status and a cross-sectional study was conducted among the 1st, 3rd year dental students (1DS, 3DS) and medical students (1MS, 3MS) of Sichuan University in Chengdu, China, in the period of September–December 2017. The data was analyzed by chi-square test using IBM SPSS Statistics v. 21.0.

Results

The oral health behavior, consciousness and status of the 1st, 3rd year medical and dental students were not optimistic. Dental freshmen were slightly superior to the medical ones in terms of the brushing methods and the awareness of oral disease-systemic disease relationship. The junior dental students showed highly significant improvement than their counterparts, mainly in the items about frequency of brushing teeth, brushing methods of vertical scrub or Bass technique (66.3%), usage of floss or mouth wash (49.7%), causes of caries, periodontal diseases and system diseases (56.9–83.4%). The rates mentioned above were 36.1, 15.8%, 26.7–43.6% among 3MS, respectively. In terms of oral health status, significant differences were only observed in junior students. The prevalence rates of bad breath, gum bleeding, and tooth discoloration among 3DS were obviously lower than those of 3MS. However, only a total of 17.2% junior students had a good oral health, including 23.8% dental students and 11.4% medical students.

Conclusions

Our study provided a new understanding of oral health knowledge, behavior and status among dental and medical students, which may help to promote the reform of oral health education and establish a model for clinicians and dentists to work together for improving oral health.

Evaluation of an educational intervention in oral health for primary care physicians: a cluster randomized controlled study

Background

Family physicians are in frequent contact with patients, and their contribution to oral health promotion programs could be utilized more effectively. We implemented an oral health care (OHC) educational seminar for physicians and evaluated its impact on their knowledge retention in OHC.

Methods

We conducted an educational trial for primary care physicians (n = 106) working in Public Health Centers in Tehran city. We launched a self-administered questionnaire about pediatric dentistry, general dental, and dentistry-related medical knowledge and backgrounds. Physicians in intervention group A (n = 38) received an educational intervention (Booklet, Continuous Medical Education (CME), and Pamphlet), and those in group B (n = 32) received only an OHC pamphlet. Group C (n = 36) served as the control. A post-intervention survey followed four months later to measure the difference in the physicians’ knowledge; the Chi-square test, ANOVA and linear regression analysis served for statistical analysis.

Results

The intervention significantly increased the physicians’ oral health knowledge scores in all three domains and their total knowledge score (p <  0.001). Those physicians who had lower knowledge scores at the baseline showed a higher increase in their post-intervention knowledge. The models showed no associations between the background variables and the knowledge change.

Conclusion

The primary care physicians’ OHC knowledge improved considerably after an educational seminar with a reminder. These findings suggest that OHC topics should be included in physicians’ CME programs or in their curriculum to promote oral health, especially among non-privileged populations.

Orthodontics in Children and Impact of Malocclusion on Adolescents' Quality of Life

Orthodontics is the dental specialty concerned with the position of teeth and the relationship between the maxilla and mandible. Much evidence regarding the characteristics of normal occlusion during childhood/adolescence, the timely referral of children/adolescents to orthodontic treatment, and the impact of orthodontic outcomes on individuals' physical, functioning, and psychosocial well-being exists in the literature. This body of evidence may be helpful for pediatricians and primary care physicians. For those willing to be skilled providers of health care to children/adolescents, knowledge of basic concepts of oral health may contribute to the communication among physicians, the young individual and their parents/caregivers.

Visits for Nontraumatic Dental Conditions in Ontario's Health Care System

BACKGROUND

Physicians' offices and emergency departments (EDs) are not suited for addressing nontraumatic dental conditions (NTDCs); however, significant numbers of people in Canada, including Ontario, visit such settings for their dental complaints. Also, people sometimes visit hospitals for day surgery to get their complicated dental conditions treated. This reflects the inefficient usage of the health care system and gaps in accessing timely dental care.

METHODS

We assessed trends in the burden of NTDCs in Ontario by estimating the visits made for such conditions to physicians, EDs, and hospitals for day surgery. Aggregate data for years 2001 to 2015 were retrieved from Intellihealth Ontario. Descriptive analysis was conducted to calculate rates of visits as stratified by sex, age groups (0 to 6, 7 to 18, 19 to 64, and ≥65 y), and jurisdictions (public health unit level).

RESULTS

On average, 70,274 visits to physicians, 51,861 to EDs, and 13,889 to hospital day surgery are made each year in Ontario for NTDCs, which costs approximately CAN$29 million. Children aged 0 to 6 y visit more than their counterparts. Statistically significant increasing trends for physician and ED visits were observed over the years. Analyses show large variations in rates of visits across public health units, with higher rates in rural communities.

CONCLUSION

A large number of visits for NTDCs, with jurisdictional variations, were consistently made to nondental health care settings in Ontario over the last 15 y. Central- and local-level policy options for optimizing resources and health care system use are required.

KNOWLEDGE TRANSFER STATEMENT

The findings of this study will provide oral and general health professionals a comprehensive understanding about the ineffective usage of a health care system for nontraumatic dental conditions. Quantifying the burden and associated dollars spent will promote crucial policy discussions to explore the possible options for providing emergency and essential dental services for all Canadians and possible equitable options to enhance access to dental care for vulnerable populations in Canadian society.

Early Childhood Caries-Related Knowledge, Attitude, and Practice: Discordance between Pediatricians and Dentists toward Medical Office-Based Prevention in Taiwan

The aim of this study was to assess the knowledge, attitude, and practice regarding early childhood caries (ECC) prevention and implementation of medical setting-based caries prevention among pediatricians and dentists in Taiwan. Data were collected from currently practicing pediatricians and general and pediatric dentists using self-administered questionnaires. A total of 301 questionnaires were completed by the pediatricians (n = 105), general dentists (n = 117), and pediatric dentists (n = 79). The pediatric dentists obtained significantly higher knowledge and practice scores than the general dentists and pediatricians (p < 0.0001). The pediatricians’ attitude score related to engaging physicians in medical office-based caries prevention was significantly higher than the attitude scores of the general and pediatric dentists (p < 0.05). A Spearman rank correlation analysis indicated a significant positive correlation between knowledge and practice among the general dentists (r_s = 0.271, p < 0.01) and pediatricians (r_s = 0.262, p < 0.01). The correlation between knowledge and attitude among the pediatricians was significantly positive (r_s = 0.242, p < 0.05). Attitude and practice among the pediatricians were significantly positively correlated (r_s = 0.271, p < 0.01). Pediatricians lacked ECC-related knowledge; however, they had a more positive attitude toward medical office-based prevention when they had a higher level of knowledge. Oral health-related education for pediatricians is necessary if such medical office-based caries prevention programs are to be implemented in Taiwan.

Qualitative exploration of barriers and facilitators of dental service utilization of pregnant women: A triangulation approach

BACKGROUND

Pregnant women are vulnerable to a wide range of oral health conditions that could be harmful to their own health and future child. Despite the usefulness of regular dental service utilization in prevention and early detection of oral diseases, it is notably low among pregnant women. In this qualitative study, we aimed to explore barriers and facilitators influencing pregnant women's dental service utilization.

METHODS

Using a triangulation approach, we included pregnant women (n = 22) from two public health centers, midwives (n = 8) and dentists (n = 12) from 12 other public centers in Tehran (Iran). Data was gathered through face-to-face semi-structured interviewing and focus group discussion methods. The analysis of qualitative data was performed using conventional content analysis with MAXQDA10 software.

RESULTS

Reported barriers of dental service utilization among pregnant women were categorized under emerging themes: Lack of knowledge and misbelief, cost of dental care, physiological changes, fear and other psychological conditions, time constraint, dentists' unwillingness to accept pregnant women treatment, cultural taboos and lack of interprofessional collaboration. Solutions proposed by dentists, midwives and pregnant women to improve dental care utilization during pregnancy were categorized under three themes: Provision of knowledge, financial support and establishing supportive policies.

CONCLUSIONS

Understanding perceived barriers of dental service utilization during pregnancy can serve as baseline information for planning and formulating appropriate oral health education, financial support, and legislations tailored for lower income pregnant women, midwives and dentists in countries with developing oral health care system.

Primary care physicians and nurses: Targets for basic periodontal education

BACKGROUND

Early diagnosis may improve patients' quality of life and reduce the lifelong social and financial burden inherent to treatment. Growing evidence supports the importance of a healthy periodontium in systemic health. Diagnosis depends on the patient and the healthcare professional. As many patients seek physicians' advice first, this study aims at assessing periodontal knowledge in a general population and their primary care physicians and nurses.

METHODS

This is a cross-sectional study using an anonymous questionnaire applied to randomly selected laypersons (March to June 2016), and to physicians and nurses at their workplaces (October to December 2016) in Ourense, Spain. Sample size for the general population was determined by quota sampling.

RESULTS

A total of 1,469 people entered the study. All healthcare workers and 624 (47.1%) laypersons were familiar with periodontitis. Bacterial etiology of periodontitis was recognized by 25 (4%) laypersons, 23 (34.3%) physicians, and 11 (16.6%) nurses. The following periodontal problems were experienced: 1) gingival redness: laypersons 14.4%, physicians 16.4%, and nurses 21.2%; 2) gingival bleeding: laypersons 22.2%, physicians 50.7%, and nurses 50%; 3) tooth mobility: laypersons 34.9%, physicians 7.4%, and nurses 6%; and 4) bleeding while toothbrushing: laypersons 44.3%, physicians 8.9%, and nurses 15.1%. More than a third of laypersons (37%) think periodontitis is related to other health problems, together with 53% of physicians and 47% of nurses.

CONCLUSIONS

Our results show a low degree of periodontal knowledge both amongst the public and their primary care physicians and nurses and unveil unreliable targets (primary healthcare workers) for educational interventions to improve early diagnosis and treatment of periodontal disorders.

Oral Health Practices Among Pakistani Physicians

Introduction

In most healthcare models, the first interaction of a patient is with a general physician. The inspection of the oral cavity is a mandatory component of the general physical examination performed by a physician. This helps detect any oral pathology and make suitable referrals. Therefore, adequate oral health awareness is essential for physicians. Our study aimed at evaluating the oral health practices among physicians working in a private teaching setup in Islamabad, Pakistan.

Methods

A cross-sectional study involving 144 physicians teaching undergraduate medical students at Shifa College of Medicine and its affiliated hospital, Shifa International Hospital, was conducted. Participants were interviewed through a self-designed questionnaire. Later, each participant demonstrated their teeth brushing technique on a standard model of the oral cavity, which was assessed against a checklist conforming to the modified bass technique. A video clip showing the aforementioned brushing technique was shown at the end of the interview. The collected data was analyzed on IBM's statistical package for the social sciences (SPSS) version 21. 

Results

Toothpaste was the top choice (97.2%) of teeth cleaning tool with 69% participants brushing their teeth two times a day and 56.9% using toothbrushes with bristles of medium texture. The use of mouthwash (32.6%) and dental floss (11.1%) was considerably low. Dental caries and teeth discoloration were seen in 46.5% and 43.8% physicians, respectively. An alarmingly low number of physicians (31.9%) claimed to have read guidelines regarding oral health. This translated into most participants (78.5%) visiting a dentist only when needed. Only 4.9% participants performed all components of the modified bass technique to clean teeth on the oral cavity model, with up to 22.9% unable to perform a single step accurately. 

Conclusion

The oral health knowledge and practices of physicians were found to be suboptimal and necessitate the integration of oral health awareness in the medical curriculum. A multiprofessional approach with physicians in crucial roles is required to address the burden of dental diseases globally.  

Barriers and facilitators in the integration of oral health into primary care: a scoping review

OBJECTIVE

This scoping study has been conducted to map the literature and provide a descriptive synthesis on the barriers and facilitators of the integration of oral health into primary care.

METHODS

Grounded in the Rainbow conceptual model and using the Levac et al six-stage framework, we performed a systematic search of electronic databases, organisational websites and grey literature from 1978 to April 2016. All publications with a focus on the integration of oral health into primary care were included except commentaries and editorials. Thematic analyses were performed to synthesise the results.

RESULTS

From a total of 1619 citations, 58 publications were included in the review. Barrier-related themes included: lack of political leadership and healthcare policies; implementation challenges; discipline-oriented education; lack of continuity of care and services and patients' oral healthcare needs. The facilitators of integration were supportive policies and resources allocation, interdisciplinary education, collaborative practices between dental and other healthcare professionals, presence of local strategic leaders and geographical proximity.

DISCUSSION AND PUBLIC HEALTH IMPLICATIONS

This work has advanced the knowledge on the barriers and facilitators at each integration domain and level, which may be helpful if the healthcare organisations decide to integrate oral health and dental services into primary care. The scoping review findings could be useful for both dental and medical workforce and allied primary healthcare providers. They could also guide the development of healthcare policies that support collaborative practices and patient-centred care in the field of primary care.

Medical Providers' Oral Health Knowledgeability, Attitudes, and Practice Behaviors: An Opportunity for Interprofessional Collaboration

OBJECTIVE

Evaluation of current knowledgeability, attitudes, and practice behaviors of medical providers from a large health care system toward oral health was undertaken as a pilot effort to better understand and integrate oral health into the overall health care delivery.

METHODS

Invitations to complete a 28-question survey, designed in a web-based platform (SurveyMonkey(®)), were emailed to 1407 medical multispecialty physicians, residents, and nurses within the health system. The questionnaire included sections on provider demographics, oral health knowledgeability and attitudes, and current practice conducting oral health screenings.

RESULTS

A 14% (n = 199/1407) response rate was achieved for survey completion. There were 16% who reported good coverage of oral/dental health topics in their medical training curriculum. Competency level was <30% for identifying tooth decay and oral pathology. There were 95% who reported never applying fluoride varnish in their practice, while >80% answered knowledge-based questions correctly. Frequency rates for dental referral by the medical providers were 32% 'frequently' and 68% 'infrequently.' Perceptions of optimal frequency for conducting oral health assessment in their professional practices ranged from 69% indicating 'frequently' to 25% indicating 'infrequently.'

CONCLUSION

Overall, positive attitudes were observed toward incorporation of oral health examination into medical practice. The study identified lack of oral health treatment and infrequent referral by medical providers to dental providers. Results support likelihood for acceptance of care models that incorporate a medical/dental team-based approach complemented by oral health training for medical providers to enhance holistic health care delivery. Limitations of this pilot study include potential selection bias and lack of generalizability beyond our institution; further studies are planned in additional settings statewide to validate findings.

Oral Hygiene Practices and Teeth Cleaning Techniques Among Medical Students

Objectives

Oral health is essential for general health and quality of life. It is a state of being free from mouth and facial pain, oral and throat cancer, oral infections and sores, periodontal disease, tooth decay, tooth loss, and other diseases and disorders that limit an individual’s capacity to bite, chew, smile, and speak; it affects psychosocial well-being too. The objective of our study was to assess teeth cleaning techniques and oral hygiene practices among medical students.

Methods

The data of the study were collected in two stages. The first stage involved the administration of a self-constructed questionnaire among medical students. In the second step, the students were asked to demonstrate their teeth cleaning techniques on a model. A standard teeth cleaning checklist was used to evaluate the students. The students were then given the checklist and a video on teeth cleaning techniques was shown to them. The data obtained was analyzed on IBM's statistical package for the social sciences (SPSS) version 21. 

Results

Out of a total of 444 students, 256 (57.7 percent) were males while 188 (42.3 percent) were females. About 254 (57.2 percent) participants were preclinical medical students while 190 (42.8 percent) were clinical year medical students. A majority of medical students used medium consistency toothbrushes (177; 39.9 percent) and soft consistency toothbrushes (137; 30.9 percent). Most medical students (248; 55.9 percent) brushed two times a day while 163 (36.7 percent) brushed only one time. About 212 (47.7 percent) of the medical students used mouthwash along with a toothbrush while only 36 (8.1 percent) used floss along with a toothbrush. About 157 participants (35.4 percent) changed their toothbrush once in two months while 132 (26.7 percent) changed their toothbrush once in three months. The mean duration that participants brushed their teeth was 134.99 ± 69.01 seconds.

Conclusion

Medical students were found to have a faulty teeth cleaning technique. There is a dire need to spread awareness about correct teeth cleaning techniques because poor oral hygiene can have a detrimental effect on the overall health and quality of life of an individual.

Performance of Preschoolers' Mothers and Senior Dental Students After Receiving Training on Fluoride Varnish Administration

OBJECTIVES

Fluoride varnish application is an effective way to prevent caries in children. We aimed to educate preschool children's mothers on how to apply fluoride varnish and compare their performance with dental students and to assess their self-reported competency six months later.

MATERIALS AND METHODS

Eighty-eight 4-6-year-old children presenting to toy houses of six randomly selected health centers in a non-affluent district of Tehran in 2014 were divided into two groups to receive fluoride varnish by their mothers and students. Mothers and senior dental students participated in a session consisting of lecture, discussion, and demonstration of fluoride varnish application for a child. Then, in three centers, mothers and in others, students applied fluoride varnish for preschoolers and their performance was evaluated. Six months later, mothers were asked to apply fluoride varnish again. Mann-Whitney U test, t-test, one-way ANOVA and logistic regression model were used for statistical analyses.

RESULTS

The mean performance score was 9.74±0.22 (out of 10) for mothers and 9.71±0.15 for students (P=0.89). After six months, the mean performance score was 9.58 for mothers, which was not significantly different from that in the first session. The age and educational level of mothers were conversely correlated to their performance (P<0.05). Of mothers, 96% believed that they were competent to repeat fluoride varnish application for their children.

CONCLUSIONS

Mothers' high performance score and the point that the majority of them felt competent to apply varnish for their children casts light on their potential key role in oral health promotion.

Oral Health Knowledge, Attitude, and Practices Among Dental and Medical Students in Eastern India - A Comparative Study

Objectives:

To compare oral health knowledge, attitude, and practices among dental and medical students in a Health care centre at Bhubaneswar, Odisha, India.

Materials and Methods:

One hundred and fifty BDS and MBBS students each from Kalinga Institute of Dental Sciences and Kalinga Institute of Medical Sciences of KIIT University, Bhubaneswar respectively, were invited to participate in this survey using a self-administered structured questionnaire in English comprising 27 questions, which was designed to evaluate the oral health knowledge, attitude, and practices. The obtained data was analyzed using the Statistical Package for the Social Sciences version 20 software.

Results:

On comparison of the scores of knowledge, attitude, and practice, the mean knowledge score was significantly higher among dental students than medical students. The study also showed that female students (both dental and medical) had better oral health knowledge and showed better oral health practices than male students. Karl Pearson's correlation coefficient test showed that, although dental students had better knowledge and attitude towards oral health, there was a lack of adequate practice among them.

Conclusion:

Further emphasis on oral health is necessary in undergraduate training to improve oral health knowledge, attitude, and practice among dental and medical students as they will act as role models for oral health education among individuals and community at large.

Knowledge, attitude, willingness and readiness of primary health care providers to provide oral health services to children in Niagara, Ontario: a cross-sectional survey

BACKGROUND

Most children are exposed to medical, but not dental, care at an early age, making primary health care providers an important player in the reduction of tooth decay. The goal of this research was to understand the feasibility of using primary health care providers in promoting oral health by assessing their knowledge, attitude, willingness and readiness in this regard.

METHODS

Using the Dillman method, a mail-in cross-sectional survey was conducted among all family physicians and pediatricians in the Niagara region of Ontario who have primary contact with children. A descriptive analysis was performed.

RESULTS

Close to 70% (181/265) of providers responded. More than 90% know that untreated tooth decay could affect the general health of a child. More than 80% examine the oral cavity for more than 50% of their child patients. However, more than 50% are not aware that white spots or lines on the tooth surface are the first signs of tooth decay. Lack of clinical time was the top reason for not performing oral disease prevention measures.

INTERPRETATION

Overall, survey responses show a positive attitude and willingness to engage in the oral health of children. To capitalize on this, there is a need to identify mechanisms of providing preventive oral health care services by primary health care providers; including improving their knowledge of oral health and addressing other potential barriers.

Dental knowledge of educators and healthcare providers working with children with autism spectrum disorders

OBJECTIVES

To evaluate dental knowledge and attitudes toward oral health care among healthcare providers and educators working with children with autism spectrum disorders (ASD) in central Saudi Arabia.  

METHODS

 There were 305 questionnaires distributed to 7 special-needs centers between September and November 2014. A total of 217 questionnaires were collected with a response rate of 71.1%. The study took place in the College of Dentistry, King Saud University, Riyadh, Kingdom of Saudi Arabia. 

RESULTS

Approximately 50.2% of the participants did not offer any toothbrushing advice, and 73.3% never recommended dental checkup visits to parents, and 75.6% never performed dental examinations to children under their care. Ten percent thought that children should have their first dental visit after 6 years of age. Almost all participants agreed that children should practice oral hygiene, and 60.4% think they should brush twice per day. In general, the participants choose toothbrushes and toothpaste as the main tools to perform oral hygiene. There were 35% of participants who believed that parents should be responsible for the children's oral hygiene, and a few participants mentioned teachers and therapists to be responsible. Most of the participants (71.4%) did not receive any dental information from dental professional resources, only 14.3% of participants believed bacteria to be the cause of dental cavities.  

CONCLUSION

There is a clear lack of dental knowledge and attitudes, and its practical application among the participating group of healthcare providers working with children with ASD in Riyadh.