A cross sectional study examining social desirability bias in caregiver reporting of children's oral health behaviors

Oral self-care among dependent older New Zealanders

OBJECTIVES

The objective of the study was to describe the occurrence and associations of oral self-care by dependent older New Zealanders.

BACKGROUND

Dependent older adults who require some level of assisted daily care have been shown to have poorer oral health than their independent counterparts, yet national estimates are lacking.

MATERIALS AND METHODS

A secondary analysis was conducted of data from New Zealand's 2012 Older People's Oral Health Survey, a national survey that interviewed and examined a representative sample of 2,218 dependent older adults living in aged residential care or receiving home-based care. Survey data were weighted for statistical analyses, and modelling was carried out using a modified Poisson approach.

RESULTS

Overall, 59.5% (95% CI: 55.1, 63.7) of participants brushed their teeth twice a day, with this rate higher among women, Asians and those without cognitive or physical impairment. Cleaning interdentally at least once a week was less common than brushing, at 25.9% (95% CI: 21.5, 30.9), and that proportion was significantly lower among those with higher dependency or who were cognitively or physically impaired. Almost 9 in 10 (87.8%; 95% CI 83.1, 91.4) used fluoride toothpaste, and adults of high socio-economic status had lower rates of fluoride toothpaste use. Only 15.0% (95% CI 12.4, 18.0) used mouthwash, with this being most prevalent in Pasifika. More than half of those who wore dentures also wore them at night.

CONCLUSION

Oral self-care was sub-optimal among dependent older New Zealanders. Improving the situation should be a high priority.

Caregiver perceptions and experiences of paediatric emergency department attendance during the COVID-19 pandemic: A mixed-methods study

Background

During the early stages of the COVID-19 pandemic, concerns were raised about reduced attendance at hospitals, particularly in paediatric emergency departments, which could result in preventable poorer outcomes and late presentations among children requiring emergency care. We aimed to investigate the impact of COVID-19 on health-seeking behaviour and decision-making processes of caregivers presenting to paediatric emergency services at a National Health Service (NHS) Trust in London.

Materials and methods

We conducted a mixed-methods study (survey and semi-structured interviews) across two hospital sites between November-December 2020. Data from each study were collected concurrently followed by data comparison.

Results

Overall, 100 caregivers participated in our study; 80 completed the survey only, two completed the interview only and 18 completed both. Our quantitative study found that almost two-thirds (63%, n = 62) of caregivers attended the department within two days of their child becoming ill. Our qualitative study identified three major themes which were underpinned by concepts of trust, safety and uncertainty and were assessed in relation to the temporal nature of the pandemic and the caregivers’ journey to care. We found most caregivers balanced their concerns of COVID-19 and a perceived “overwhelmed” NHS by speaking to trusted sources, predominantly general practitioners (GPs).

Conclusion

Caregivers have adapted their health-seeking behaviour throughout the pandemic as new information and guidance have been released. We identified several factors affecting decisions to attend; some existed before the pandemic (e.g., concerns for child’s health) whilst others were due to the pandemic (e.g., perceived risks of transmission when accessing healthcare services). We recommend trusted medical professionals, particularly GPs, continue to provide reassurance to caregivers to seek emergency paediatric care when required. Communicating the hospital safety procedures and the importance of early intervention to caregivers could additionally provide reassurance to those concerned about the risks of accessing the hospital environment.

Development and validation of a short form of the BOHLAT-P

The authors developed and validated a short form of the Brazilian Oral Health Literacy Assessment Task for Paediatric Dentistry (BOHLAT-P). Data included responses from 200 parents of preschoolers to sociodemographic and oral health service access questions on the BOHLAT-P, the Brazilian Rapid Estimate of Adult Literacy in Dentistry (BREALD-30), and the Brazilian Early Childhood Oral Health Impact Scale (B-ECOHIS). Data on the preschoolers' dental caries experience (ICDAS-II) were also included. An item response theory-based approach was employed to develop the short form, while confirmatory factor analysis evaluated the instrument dimensionality. The validity and reliability of the short form were tested by statistical analysis using BREALD-30, B-ECOHIS, and sociodemographic and dental caries experience data. The short form (BOHLAT-P-30) comprises 30 items, is unidimensional, and presents better model fit estimates (TLI = 0.94; CFI = 0.94; RMSEA = 0.05) than those of the BOHLAT-P. Moreover, BOHLAT-P-30 demonstrated excellent reliability (Cronbach's alpha = 0.91; intraclass correlation coefficient [ICC] = 0.95). BOHLAT-P-30 scores were positively correlated with BREALD-30 scores (r = 0.71), with the number of years of schooling (r = 0.60), and with the number of hours spent reading (r = 0.33). BOHLAT-P-30 scores were negatively correlated with B-ECOHIS scores (r = -0.21), and with the number of teeth with cavitated caries (r = -0.18). After controlling for confounding factors, BOHLAT-P-30 scores were not found to be associated with caries presence, or with the number of teeth with cavitated caries. The BOHLAT-P-30 had properties similar to those of the BOHLAT-P, and proved to be a valid measure to assess the OHL of Brazilian parents.

Toothache, tooth brushing frequency and dental check-ups in children and adolescents with and without disabilities

According to international studies, children and adolescents with disabilities have more tooth decay, brush their teeth less often twice a day and use preventive dental services less often than children and adolescents without disabilities. With data from the second follow-up to the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017), toothache, tooth brushing frequency and dental check-ups are examined in children and adolescents with and without disabilities. It was found that children and adolescents with disabilities had more toothache in the three months before the survey (23.5% and 15.9%, respectively) and brushed or got their teeth brushed twice a day less often (33.5% and 22.2%, respectively) than children and adolescents without disabilities. Differences in the utilisation of dental check-ups could not be determined. Overall, the results point to the importance of measures to promote tooth brushing frequency in order to improve the oral health of children and adolescents with disabilities. In addition, further opportunities should be created to collect data on the oral health of people with disabilities at the population level in health or participation studies.

Oral Health Status of Hearing-Impaired Students Attending Special Need Schools in Amhara Region, Ethiopia: A Cross-Sectional Study

Background

Oral health care is the most common unmet need among individuals with a disability. Individuals with a disability may have compromised oral health needs due to neglect from parents, socioeconomic problems, and communication barriers. In Ethiopia, there is a lack of data on oral health status of the hearing-impaired population. Therefore, this study aimed to assess the oral health status of hearing-impaired students in the Amhara region, Ethiopia.

Methods

A cross-sectional study was conducted from November 2020 to April 2021 on hearing-impaired students in Amhara region, Ethiopia. Data were collected using a pretested interview administered questionnaire and clinical examination. Oral cavity was evaluated using the simplified oral hygiene index, decayed, missed and filled teeth, and community periodontal index. Data analysis was done using SPSS 26.0, and logistic regression analysis was done to identify the risk factors of dental caries and periodontal disease.

Results

A total of 149 hearing impaired students with an age range of 7–30 years were involved in the study. The prevalence of periodontal disease and dental caries was 22.8% (95% CI: 16.8, 30.4) and 38.9% (95% CI; 32.2, 46.9), respectively. Being grade 1–4 student (AOR = 3.94, 95%: 1.16, 13.38), lack of formal education (AOR = 4.98, 95% CI: 1.00, 24.65), dental caries (AOR = 2.51, 95% CI: 1.08, 5.08) and bleeding on probing (AOR = 9.98, 95% CI: 3.69, 26.64) were statistically significant with periodontal disease. Grade level, parents’ support during brushing, oral health status, and medication intake were independent factors for dental caries.

Conclusion

In the present study, a significant number of hearing-impaired students had periodontal disease and dental caries. School oral health programs and caregivers assisted oral hygiene practices are essential to combat oral health problems in hearing-impaired students. Moreover, a nationwide prospective study with a large sample size will be required to reflect the oral health status of hearing-impaired individuals in the country.

Guardian Reports of Children's Sub-optimal Oral Health Are Associated With Clinically Determined Early Childhood Caries, Unrestored Caries Lesions, and History of Toothaches

Background: Parents'/guardians' perceptions of their children's oral health are useful proxies of their clinically determined caries status and are known to influence dental care-seeking behavior. In this study, we sought to examine (1) the social and behavioral correlates of fair/poor child oral health reported by guardians and (2) quantify the association of these reports with the prevalence of early childhood caries (ECC), unrestored caries lesions and toothaches. Methods: We used guardian-reported child oral health information (dichotomized as fair/poor vs. excellent/very good/good) obtained via a parent questionnaire that was completed for n = 7,965 participants (mean age = 52 months; range = 36-71 months) of a community-based, cross-sectional epidemiologic study of early childhood oral health in North Carolina between 2016 and 2019. Social, demographic, oral health-related behavioral data, and reports on children's history of toothaches (excluding teething) were collected in the same questionnaire. Unrestored ECC (i.e., caries lesions) was measured via clinical examinations in a subset of n = 6,328 children and was defined as the presence of one or more tooth surfaces with an ICDAS ≥ 3 caries lesion. Analyses relied on descriptive and bivariate methods, and multivariate modeling with average marginal effect (A.M.E.) estimation accounting for the clustered nature of the data. Estimates of association [prevalence ratios (PR) and adjusted marginal effects (AME) with 95% confidence intervals (CI)] were obtained via multilevel generalized linear models using Stata's svy function and accounting for the clustered nature of the data. Results: The prevalence of fair/poor oral health in this sample was 15%-it increased monotonically with children's age, was inversely associated with parents' educational attainment, and was higher among Hispanics (21%) and African Americans (15%) compared to non-Hispanic whites (11%). Brushing less than twice a day, not having a dental home, and frequently consuming sugar-containing snacks and beverages were significantly associated with worse reports (P < 0.0005). Children with fair/poor reported oral health were twice as likely to have unrestored caries lesions [prevalence ratio (PR) = 2.0; 95% confidence interval (CI) = 1.8-2.1] and 3.5 times as likely to have experienced toothaches [PR = 3.5; 95% CI = 3.1-3.9] compared to those with better reported oral health. Conclusions: Guardian reports of their children's oral health are valuable indicators of clinical and public health-important child oral health status. Those with fair/poor guardian-reported child oral health have distinguishing characteristics spanning socio-demographics, oral-health related practices, diet, and presence of a dental home.

Lessons Learnt From the Experiences of Primary Care Physicians Facing COVID-19 in Benin: A Mixed-Methods Study

Introduction

In sub-Saharan Africa, there is a need to better understand and guide the practice of primary care physicians (PCPs), especially in a crisis context like the COVID-19 pandemic. This study analyses the experiences of PCPs facing COVID-19 in Benin and draws policy lessons.

Methods

The study followed a fully mixed sequential dominant status design. Data were collected between April and August 2020 from a sample of PCPs in Benin. We performed descriptive analyses on the quantitative data. We also performed bivariate analyses for testing associations between various outcomes and the public/private status of the PCPs, their localization within or outside the cordon sanitaire put in place at the beginning of COVID-19, and their practice' category. A thematic content analysis was done on qualitative data. Results from both analyses were triangulated.

Results

Ninety PCPs participated in the quantitative strand, and 14 in the qualitative. The median percentage of the COVID-19 control measures implemented in the health facilities, as reported by the PCPs, was 77.8% (interquartile range = 16.7%), with no difference between the various groups. While 29.4% of the PCPs reported being poorly/not capable of helping the communities to deal with COVID-19, 45.3% felt poorly/not confident in dealing with an actual case. These percentages were bigger in the private sector. The PCP's experiences were marked by anxiety and fear, with 80.2% reporting stress. Many PCPs (74.1%) reported not receiving support from local health authorities, and 75.3% felt their concerns were not adequately addressed. Both percentages were higher in the private sector. The PCPs especially complained of insufficient training, insufficient coordination, and less support to private providers than the public ones. For 72.4 and 79.3% of the PCPs, respectively, the pandemic impacted services utilization and daily work. There were negative impacts (like a decrease in the services utilization or the quality of care), but also positive ones (like improved compliance to hygiene measures and new opportunities).

Conclusion

Our study highlighted the need for more structured support to PCPs for optimizing their contribution to epidemics control and good primary healthcare in Benin. Efforts in this direction can build on several good practices and opportunities.

Attention-deficit Disorder, Family Factors, and Oral Health Literacy

Introduction

Relationships amongst attention-deficit/hyperactivity disorder (ADHD), family factors, and oral health literacy (OHL) in adolescents are unclear. The objective of this research was to investigate whether family environment and signs of ADHD are associated with OHL at the onset of adolescence.

Methods

A cross-sectional study was performed with 448 twelve-year-old adolescents enrolled in schools in Cajazeiras, Brazil. Adolescents responded to an instrument measuring OHL (Brazilian version of the Rapid Estimate of Adult Literacy in Dentistry [BREALD-30]) and a validated questionnaire addressing family cohesion and adaptability (Family Adaptability and Cohesion Scales [FACES III]). Parents and teachers answered subscales of the Swanson, Nolan, and Pelham Questionnaire (SNAP-IV) and a socioeconomic questionnaire. Adjusted Poisson regression analysis was employed for the data analysis (P < .05).

Results

Greater OHL was found in adolescents with higher family cohesion scores (rate ratio [RR], 1.02; 95% confidence interval [CI], 1.01–1.03), those whose mothers had more than 8 years of schooling (RR, 1.07; 95% CI, 1.03–1.12), and those whose families earned more than the Brazilian minimum salary (RR, 1.08; 95% CI, 1.03–1.12). Higher family adaptability scores (RR, 0.99; 95% CI, 0.98–0.99) and more signs of ADHD (teachers’ reports) (RR, 0.95; 95% CI, 0.91–0.99) were associated with lower OHL.

Conclusions

OHL in adolescents was influenced by family adaptability and cohesion, signs of ADHD, maternal schooling, and family income.

The Association Between Medicaid Adult Dental Coverage And Children's Oral Health

Although all state Medicaid programs cover children's dental care, Medicaid-eligible children are more likely to experience tooth decay than children in higher-income families. Using data from the 1999-2016 National Health and Nutrition Examination Survey and the 2003, 2007, and 2011-12 waves of the National Survey of Children's Health, we examined the association between Medicaid adult dental coverage (an optional benefit) and children's oral health. Adult dental coverage was associated with a statistically significant 5-percentage-point reduction in the prevalence of untreated caries among children after Medicaid-enrolled adults had access to coverage for at least one year. These policies were also associated with a reduction in parent-reported fair or poor child oral health with a two-year lag between the onset of the policy and the effect. Effects were concentrated among children younger than age twelve. We estimated declines in poor oral health among all racial and ethnic subgroups, although there was some evidence that non-Hispanic Black children experienced larger and more persistent effects than non-Hispanic White children. Future assessments of the costs and benefits of offering adult dental coverage may consider potential effects on the children of adult Medicaid enrollees.

Clinician and carer moral concerns when caring for children who tube-feed

Child healthcare can be vexed by moral concerns - this extends to the care of children who tube-feed. Children who tube-feed often receive care from family members and clinicians of various disciplines. Each brings expertise, experiences, values, and views to a situation, prioritising the child's needs while attending to those they deem important in potentially disparate ways. Their understanding of a situation is shaped by beliefs, feelings, and perceptions. How then are key decisions made about the care of a child who tube-feeds? This article explores clinicians' and carers' moral concerns when caring for children who tube-feed. Interviews with clinicians (n = 9) and carers (n = 9) clarified three findings: first, there are often disparate beliefs about the need for tube-feeding; second, tube-feeding can evoke strong emotions; and third, it can be difficult to normalise tube-feeding. This article demonstrates how challenges can emerge when relationships between clinicians and carers diverge. Furthermore, it establishes how an ethic of care can bring different interests together to bolster the relationships required to optimise feeding care and promote health outcomes among children who tube-feed and their carers. This requires improved dialogue between and among clinicians and carers to create shared understandings of what is, what should be, and how to benefit children who tube-feed.

Pathways linking parental health literacy with health behaviours directed at the child: a scoping review

Health literacy (HL) is thought to be crucial for the management of the manifold demands relating to child health which parents are faced with. Albeit many studies have investigated parental HL and health behaviours (HBs) directed at the child, knowledge about the pathways which link parental HL with HB is scarce. The aim of this scoping review was to identify and comprehensively describe the variety of pathways linking parental HL with HBs directed at the child which were empirically analysed in previous studies. Following established scoping review methods database searches were conducted in MEDLINE, EMBASE, PsycINFO and WebofScience on 5 March 2020. Eligibility criteria included primary, empirical studies assessing parental HL and HB directed at the child in the general parent population. Titles and abstracts were screened independently by six reviewers for potentially relevant publications and data were extracted using standardized data extraction forms. The search identified 6916 articles for title and abstract screening. After full-text review, 50 studies were included in this review. Most studies (N = 24) assumed a direct association between HL and HBs and only few studies (N = 4) used more complex models investigating different pathways or mediation and/or moderation models. Overall, the evidence on the underlying pathways linking parental HL and HBs directed at the child is mixed and fairly limited. Therefore, hypothesis-driven research and integration of results into theoretical frameworks is needed for advancing both the research on HL and public health practice.

Children's oral health-related behaviours and early childhood caries: A latent class analysis

OBJECTIVE

In this cross-sectional study in a large community-based sample of preschool-age children, we sought to identify distinct clusters of modifiable early childhood oral health-related behaviours (OHBs) and quantify their association with clinical and parent-reported measures of early childhood oral health.

METHODS

We relied upon a questionnaire (n = 8033; 11% in Spanish) and clinical oral health data (n = 6404; early childhood caries [ECC] prevalence = 54%] collected in the context of an epidemiologic study of early childhood oral health among 3- to 5-year-old children in North Carolina. Latent class analysis was used to identify clusters of modifiable OHBs based on parents' responses to 6 questionnaire items pertaining to their children's oral hygiene, diet and dental home. The optimal number of clusters was determined based on measures of model fit and interpretability. We examined associations of OHB clusters with clinical and parent-reported child oral health status (ie, ECC prevalence, severity and proportion with untreated disease) using bivariate association tests and multivariable regression modelling with marginal effects estimation accounting for clustered data. We used Mplus v.8.6 (Muthén & Muthén, Los Angeles, CA, USA) and Stata v.16.1 (StataCorp, College Station, TX, USA) for data analyses.

RESULTS

We identified 2 OHB clusters, a favourable (74%) and an unfavourable (26%) one. Children in the favourable OHB cluster had better oral hygiene practices (ie, tooth brushing frequency and fluoridated toothpaste use), lower consumption frequency of sugar-containing snacks and beverages, less frequent reports of night-time bottle-feeding history and a higher likelihood of a dental home. Children in the unfavourable cluster had significantly higher ECC prevalence (57% vs 53%), caries burden (mean dmfs = 9.3 vs 7.6), untreated disease (43% vs 33%) and worse parent-reported oral health status than the favourable cluster.

CONCLUSIONS

Our findings demonstrate the importance and utility of clustering common, modifiable ECC risk factors in population studies - health promotion efforts may centre on groups of people rather than individual behavioural risk factors.

Development and pilot testing of an oral hygiene self-care photonovel for Punjabi immigrants: a qualitative study

INTRODUCTION

The purpose of this research study was to develop and pilot test a culturally and linguistically appropriate oral hygiene self-care photonovel for Punjabi immigrants.

METHODS

Purposeful sampling technique was used to recruit 5 members of a Punjabi community organization (the Sikh Women's Association of Montreal) for participation in 3 focus group sessions in August 2015. A thematic content analysis approach was used to sort the data, enabling identification of the storyline and photonovel contents from the themes that emerged. Comic Life 3 version 3.1.1 software was used to create a "Safeguard Your Smile" (SYS) photonovel, which was printed for pilot testing. Ten additional participants were recruited for this pilot testing, enabling further revision of the photonovel based on their suggestions.

RESULTS

Four major themes emerged from the focus group discussions: 1) lack of understanding of oral hygiene self-care and risk factors; 2) lack of oral hygiene self-care-related awareness and routine; 3) lack of emphasis on prevention by oral health care providers; and 4) perceived barriers to accessing dental health care. Thematic content analysis revealed a lack of knowledge of oral hygiene self-care skills and routine. Guided by these overarching themes, a final version of the photonovel script was created including photographs of key characters. The photonovel was subsequently printed for pilot testing. Pilot test results revealed close to 80% of participants agreed that the SYS photonovel was culturally and linguistically appropriate and easy to understand.

CONCLUSIONS

A culturally and linguistically appropriate photonovel may be a useful tool for enhancing oral hygiene self-care knowledge among ethnic communities. Further studies are required to test the effectiveness of such a tool.

Examining Parental Treatment Decisions Within a Contemporary Pediatric Dentistry Private Practice

PURPOSE

The primary objective of this study was to compare relationships between child, parent, and clinical factors with patient-level treatment decisions for early childhood caries. A secondary objective was to describe children that received silver diamine fluoride (SDF) as interim versus long-term treatment.

PATIENTS AND METHODS

Parents of 2-6-year-old children seeking care at a multi-center pediatric dentistry private practice were enrolled in this cross-sectional study. Demographic data and dental anxiety data according to the Modified Corah's Dental Anxiety Scale were collected via questionnaire. A dental visit behavior rating and decayed, missing, and filled tooth (dmft) index were recorded from the child's dental record. The primary outcome was treatment decision categorized into three groups: (1) treatment with SDF (n=25), (2) conventional restorative treatment under local anesthesia (n=32), and (3) restorative treatment under general anesthesia (n=33). Analyses included descriptive statistics, bivariate analysis, and ordered logistic regression.

RESULTS

Child age, parent education level, family income, dental insurance status, dental visit behavior rating, and dmft were significantly different across treatment groups in bivariate comparisons. However, when included in multivariable, ordered logistic regression, child dental anxiety was the only significant covariate associated with treatment decisions (Odds Ratio=5.01, 95% confidence interval: 1.51 to 16.63). In secondary analysis, two distinct subgroups were identified within the SDF group: one as long-term treatment (n=9) and one as interim treatment prior to general anesthesia (n=16). The long-term group was younger (mean=3.2 versus 3.7), had lower dmft (mean=4 versus 11.1), and had lower frequency of very high dental anxiety (0% versus 15%).

CONCLUSION

The present study identified child dental anxiety as the primary factor associated with treatment decisions at this private practice. The characterization of two subgroups of children treated with SDF has meaningful implications for studies evaluating the economic and public health impacts of SDF.

First Permanent Molar Caries and Oral Health Practices in Saudi Male Teenagers: Inequalities by Socioeconomic Position

OBJECTIVES

Caries remains a problem in high-risk groups aggravated by socioeconomic inequalities. The study aimed to investigate (1) oral health practices associated with caries in the 1^st permanent molars in Saudi male teenagers and (2) the impact of socioeconomic position (SEP) on caries control using these practices.

METHODS

A cross-sectional study targeted 1137 male teenagers in intermediate schools in Khobar and Dammam, Saudi Arabia, in 2016. Caries was examined using the World Health Organization criteria and plaque was assessed using the plaque index of Loe and Silness. A questionnaire assessed SEP (parental education, employment, and home ownership) and oral health practices (using fluoridated toothpaste twice daily, regular dental visits for check-ups, and avoiding daily sugary snacks). Regression models analysed the association of these factors with caries presence and the mean number of decayed 1^st permanent molars. Stratification was used to assess differences between SEP levels.

RESULTS

The response rate was 81.7%. Caries prevalence and mean (SD) number of decayed 1^st permanent molars were 50.4% and 1.08 (1.31). The use of fluoride toothpaste was associated with lower odds of caries and fewer decayed molars (OR = 0.50 and regression coefficient = -0.35). Differences in the relationship between caries and toothpaste were observed by SEP levels with stronger associations in less advantaged groups.

CONCLUSIONS

Brushing twice daily using fluoride toothpaste was associated with less caries in Saudi male teenagers with stronger association observed in groups with lower SEP. The use of fluoride toothpaste helps in reducing health inequalities associated with SEP.

Increasing questionnaire response: evidence from a nested RCT within a longitudinal birth cohort study

Background

High response rates are essential when questionnaires are used within research, as representativeness can affect the validity of studies and the ability to generalise the findings to a wider population.

The study aimed to measure the response rate to questionnaires from a large longitudinal epidemiological study and sought to determine if any changes made throughout data collection had a positive impact on the response to questionnaires and addressed any imbalance in response rates by participants’ levels of deprivation.

Methods

Data were taken from a prospective, comparative study, designed to examine the effects of the reintroduction of water fluoridation on children’s oral health over a five-year period. Response rates were analysed for the first year of data collection. During this year changes were made to the questionnaire layout and cover letter to attempt to increase response rates. Additionally a nested randomised control trial compared the effect on response rates of three different reminders to complete questionnaires.

Results

Data were available for 1824 individuals. Sending the complete questionnaire again to non-responders resulted in the highest level of response (25%). A telephone call to participants was the only method that appeared to address the imbalance in deprivation, with a mean difference in deprivation score of 2.65 (95% CI -15.50 to 10.20) between the responders and non-responders.

Conclusions

Initially, low response rates were recorded within this large, longitudinal study giving rise to concerns about non-response bias. Resending the entire questionnaire again was the most effective way of reminding participants to complete the questionnaire. As this is a less labour intensive method than for example, calling participants, more time can then be spent targeting groups who are underrepresented. In order to address these biases, data can be weighted in order to draw conclusions about the population.

Pediatric dental care use and parent- or caregiver-rated oral health among Alabama children enrolled in Medicaid

BACKGROUND

Reducing caries and improving access to dental care is a public health challenge. Understanding low use of dental care is of critical importance. This study estimated parent- or caregiver-reported prevalence and identified factors associated with children's dental care use, including the association with children's oral health.

METHODS

A cross-sectional analysis of children enrolled in Medicaid in Alabama, using data from the 2017 statewide Consumer Assessment of Healthcare Providers and Systems Health Plan Survey, was conducted. Associations were measured using adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) from logit regression and generalized linear model postestimation of least-squares means.

RESULTS

The 6-month prevalence of children receiving dental care was 70.4%. Children aged 0 through 3 years (aPR, 0.72; 95% CI, 0.53 to 0.91) had lower prevalence of care than other age groups. The prevalence of low-rated oral health was 9.2%. Low-rated oral health was associated with not receiving dental care (aPR, 1.50; 95% CI, 1.12 to 1.87) and parental education of 8th grade or less (aPR, 2.59; 95% CI, 1.20 to 3.98). Falsification tests determined that dental care use was not associated with ratings for overall health (aPR, 1.18; 95% CI, 0.83 to 1.52) or emotional health (aPR, 1.06; 95% CI, 0.79 to 1.33).

CONCLUSIONS

It was observed that children not receiving dental care had low-rated oral health; however, as a cross-sectional study, it was not possible to assess the temporality of this relationship.

PRACTICAL IMPLICATIONS

Oral health care providers should continue to recognize their role in educating parents and providing anticipatory guidance on children's oral health.

Parenting stress as a mediator in the oral health of children and adolescents: A stress process model

OBJECTIVES

We tested hypotheses regarding socioeconomic status (SES) disparities in oral health amongst children and adolescents and the extent to which such SES disparities may be mediated by parenting stress.

METHODS

We analysed data from the 2011/2012 US National Survey of Children's Health for ages 6-11 years (n = 21 596) and 12-17 years (n = 23 584). Our models estimated associations between SES indicators (family income and parental education) and parenting stress with two oral health outcomes: parent-reported child oral health and preventive dental visits.

RESULTS

For both age groups, SES was positively associated with both oral health outcomes. Parenting stress mediated the relationship between SES and child oral health, not preventive dental visits-such that lower SES was associated with worse oral health via higher parenting stress. Amongst children, the indirect effect of parenting stress was observed for parental education and family income, whilst amongst adolescents, no indirect effect of parenting stress was observed.

CONCLUSION

Parenting stress was an important determinant of children's oral health and partially explained the SES-related oral health disparities in children. Future research is needed to explore the causal pathways in this association.

Impact of Health Promotion Interventions on Early Childhood Caries Prevention in Children Aged 2-5 Years Receiving Dental Treatment Under General Anesthesia

Aim: This study was conducted to evaluate the impact of health promotion interventions on early childhood caries prevention in 2–5 year-olds receiving dental treatment under general anesthesia.

Materials and Methods: Thirty-seven mother-child couples presenting to the clinic of the Dental School of Tehran University of Medical Sciences for treatment under general anesthesia were randomly divided to two groups: 19 couples in the pamphlet and fluoride varnish four times a year, and 18 couples in the pamphlet plus six phone call reminders and fluoride varnish four times a year. A standard questionnaire on demographics and children oral health-related practice of parents was completed by respondents. On children's oral examination, the Simplified Oral Hygiene Index (OHI-S), dmft, and the presence of new white spot lesions (WS) were recorded in both phases. At the final stage, Early Childhood Oral Health Impact Scale (ECOHIS) was completed by parents. The length of follow-up was 24 months.

Results: In both groups, there was an increase in the number of mothers who knew how to brush their children's teeth as well as the number of mothers who brushed their children's teeth (P < 0.05). In the reminder group, an improvement occurred in the mothers' perception of their perceived ability to make their children brush their teeth twice a day (P = 0.03). Clinical examination revealed a significant decrease in the OHI-S (from 1.9 ± 0.8 to 1.15 ± 0.5) and the number of WS (from 8.5 ± 5.5 to 0.08 ± 0.5) in both groups on the follow-up visit. The mean dmft was 11.0 ± 4.0 with a mean d component of 10.56 ± 4 at the baseline, which decreased significantly to 1.44 ± 1.96 after dental treatment. No significant increase was seen in new caries in the intervention groups. There was no significant difference in the ECOHIS score between the two groups.

Conclusion: The similar impact of both interventions suggests the possibility of applying the simpler one, i.e., the educational pamphlet, fluoride varnish and frequent follow-ups. However, in the reminder group, the mothers' perception of their perceived ability to make children brush their teeth twice a day was improved.

Adolescents with worse levels of oral health literacy have more cavitated carious lesions

The aim of the present study was to investigate whether the ability to recognize and read oral health terms is associated with the number of teeth with cavitated carious lesions in adolescents. A population-based cross-sectional study was conducted involving a sample of 746 adolescents representative of students aged 15 to 19 years at the public and private school systems in a city in northeast Brazil. Two examiners who had undergone a training and calibration exercise (inter-examiner and intra-examiner Kappa coefficient: 0.87 to 0.93) performed the diagnosis of caries using the Nyvad Index and evaluated the level of OHL (BREALD-30) of the adolescents. The participants answered questions regarding their history of visits to the dentist and the parents/caregivers answered a questionnaire addressing socioeconomic characteristics. A directed acyclic graph was created to direct the selection of covariables for adjustments in the Poisson multiple regression analysis to test the association between dental caries and OHL (α = 5%). Cavitated carious lesions (codes 3 to 6 on the Nyvad index) were found in 41.6% of the adolescents. Only 29.4% had a high level of OHL (BREALD-30 scores between 23 and 30); 42.3% of the families belonged to the A-B social class and 93% of the adolescents had been to the dentist at least once in their lifetimes. In the multivariate analysis, adolescents with inadequate (PR: 1.69; 95% CI: 1.18–2.41; p = 0.004) and marginal (PR; 1.42; 95% CI: 1.01–1.99; p = 0.042) OHL and those in the lower social classes (C-D-E) (PR: 1.85; 95% CI: 1.39–2.47; p<0.001) had more teeth with cavitated carious lesions. In conclusion, adolescents aged 15 to 19 years with poorer levels of OHL had a larger number of teeth with cavitated carious lesions, independently of their socioeconomic status and history of visiting a dentist.

"Strong Teeth"-a study protocol for an early-phase feasibility trial of a complex oral health intervention delivered by dental teams to parents of young children

Background

Dental attendance provides an important opportunity for dental teams to explore with parents the oral health behaviours they undertake for their young children (0–5 years old). For these discussions to be effective, dental professionals need to be skilled in behaviour change conversations. The current evidence suggests that dental teams need further support, training and resources in this area. Therefore, the University of Leeds and Oral-B (Procter & Gamble Company) have worked with the local community and dental professionals to co-develop “Strong Teeth” (an oral health intervention), which is delivered in a general dental practice setting by the whole dental team. The protocol for this early phase study will explore the feasibility and acceptability of the Strong Teeth intervention to parents and the dental team, as well as explore short-term changes in oral health behaviour.

Methods

Forty parents (20 of children aged 0–2 years old, and 20 of children aged 3–5 years old) who are about to attend the dentist for their child’s regular dental check-up will be recruited to the study. Parents and children will be recruited from 4 to 8 different dental practices. In the home setting, consent and baseline oral health behaviour data will be collected. The researchers will ask parents questions about their child’s oral health behaviours, including toothbrushing and diet. Three different proxy objective measures of toothbrushing will be collected and compared with self-report measures of parental supervised toothbrushing (PSB).

Discussion

The parent and child will then attend their dental visit and receive the Strong Teeth intervention, delivered by the dental team. This intervention should take 5–15 min to be delivered, in addition to the routine dental check-up. Furthermore, children aged 0–2 years old will receive an Oral-B manual children’s toothbrush, and children aged 3–5 years old will receive an Oral-B electric rechargeable children’s toothbrush. At 2 weeks and 2–3 months following the Strong Teeth intervention, further self-report and objective measures will be collected in the parent/child’s home. This data will be supplemented with purposively sampled qualitative interviews with parents (approximately 3 months following the intervention) and dental team members (following delivery of the intervention).

Trial registration

ISRCTN Register, (ISRCTN10709150)

Electronic supplementary material

The online version of this article (10.1186/s40814-019-0483-9) contains supplementary material, which is available to authorized users.

Evaluating Child Toothbrushing Behavior Changes Associated with a Mobile Game App: A Single Arm Pre/Post Pilot Study

Purpose: The purpose of this pilot study was to evaluate changes in toothbrushing behaviors associated with a mobile game app. Methods: Thirty-four five- to six-year-olds were taught to use the Brush UpTM game app and played it once per day at home for seven days. The primary outcome was toothbrushing quality measured as duration and distribution. The paired t test was used to assess pre/post changes and Holm's method adjusted for multiple testing (α equals 0.05). Results: The mean age was 73.7±6.6 months; 29.4 percent were female, and 47.1 percent were Caucasian. After seven days, toothbrushing duration increased significantly (P<0.001). Toothbrushing distribution improved with increased brushing of the lingual, maxillary occlusal, and posterior buccal surfaces. For 15 children who played the game for 14 days, even greater improvements in quality and distribution were observed. Improvements in toothbrushing did not persist one year later without further app use but there were noted changes that could be clinically meaningful. Conclusions: Mobile health game apps can potentially improve toothbrushing quality in children. Additional trials are needed to assess mobile toothbrushing game apps.

Caregiver’s oral health literacy is associated with prevalence of untreated dental caries in preschool children

Abstract The aim of this study was to evaluate the relationship between oral health literacy (OHL) among caregivers and untreated dental caries among preschoolers. A cross-sectional study was conducted involving 415 preschool children and their caregivers from Curitiba, Brazil. The children were examined for dental caries and dental plaque. The caregivers’ OHL was evaluated using an instrument translated and validated for Brazilian Portuguese: the Brazilian Rapid Estimate of Adult Literacy in Dentistry-30. The prevalence of children with untreated caries was 42.9% (95%CI: 38.1-47.7%). A low degree of OHL was found among 15.7% (95%CI: 12.2-19.2) of caregivers. The multivariable Poisson regression analysis indicated a higher prevalence of untreated caries among children whose caregivers had a low OHL (PR = 1.35; 95% CI: 1.01-1.79), those with visible plaque (PR = 1.28; 95% CI: 1.01-1.62) and those who never or only occasionally had their teeth brushed by their caregivers (PR = 1.48; 95% CI: 1.16-1.91) in comparison to those without these conditions. In conclusion, a higher prevalence of untreated dental caries was found among preschool children whose caregivers had a low degree of OHL.

The Impact of Policy Modifiable Factors on Inequalities in Rates of Child Dental Caries in Australia

Background: Poor oral health in childhood can lead to adverse impacts later in life. We aimed to estimate the prevalence and population distribution of childhood dental caries in Australia and investigate factors that might ameliorate inequalities. Methods: Data from the nationally representative birth cohort Longitudinal Study of Australian Children (N = 5107), using questions assessing: The experience of dental caries during each biennial follow-up period (2–3 years to 10–11 years), socioeconomic position (SEP), and policy modifiable oral health factors. Results: The odds of dental caries were higher for children with lowest vs. highest SEP (adjusted OR (adjOR) 1.92, 95% CI 1.49–2.46), and lower where water was fluoridated to recommended levels (adjOR 0.53, 95% CI 0.43–0.64). There was no evidence of an association between caries experience and either reported sugary diet or tooth brushing. When SEP and fluoridation were considered in conjunction, compared to the highest SEP group with water fluoridation children in the lowest SEP with fluoridation had adjOR 1.54 for caries, (95% CI 1.14–2.07), and children in the lowest SEP without fluoridation had adjOR 4.06 (95% CI 2.88–5.42). For patterns of service use: The highest SEP group reported a greater percentage of service use in the absence of caries. Conclusions: Dental caries appears prevalent and is socially distributed in Australia. Policy efforts should consider how to ensure that children with dental caries receive adequate prevention and early care with equitable uptake.

Effectiveness of "Safeguard Your Smile," an oral health literacy intervention, on oral hygiene self-care behaviour among Punjabi immigrants:A randomized controlled trial

BACKGROUND

Research shows that immigrants have higher rates of oral diseases, poorer access to dental care services, and lower levels of health literacy than their Canadian-born peers. Oral health literacy has emerged as a potential pathway to reduce oral health disparities. The scarcity of studies on oral health literacy interventions, particularly among immigrants, lent urgency to this study, the purpose of which was to evaluate the effectiveness of an oral health literacy intervention promoting oral hygiene self-care behaviour among Punjabi immigrants.

METHODS

The study used a parallel group, non-blinded, randomized controlled trial design. One hundred and forty (140) Punjabi immigrants between 18 and 60 years of age were enrolled. Participants were randomly allocated to receive either the Safeguard Your Smile (SYS) intervention or a conventional pamphlet. The following outcome measures were assessed at baseline and 3 months post-intervention: self-reported oral hygiene self-care behaviour and knowledge, plaque and gingival indices, and oral health literacy. A linear mixed model for repeated measures was used to compare the intervention and control groups (between) at pre- and post-intervention (within).

RESULTS

Participants who received the SYS intervention showed improvements ( p <0.0001) for the following dependent variables: oral hygiene self-care knowledge and behaviour, oral health literacy, and plaque and gingival indices.

CONCLUSIONS

SYS intervention enhanced positive oral hygiene self-care behaviour among Punjabi immigrants with low oral health literacy. SYS intervention can be employed among other vulnerable groups with low levels of oral health literacy to improve oral hygiene self-care behaviour.

Effect of Road Safety Education on Road Risky Behaviors of Spanish Children and Adolescents: Findings from a National Study

Background: Road Safety Education (RSE) is widely known as a reliable determinant of the future results for what concerns health and welfare and as an undisputable factor which contributes to the social behavior of individuals and to their mid- and long-term road safety outcomes. However, its development has been relatively scarce in most countries, a fact which has contributed to letting matters as delicate as traffic crashes, largely explained by road misbehaviors, continue to be a prevalent problem, thus affecting the health of the community. Objective: The aim of this study was to describe the relationship between demographic and RSE-related variables and the self-reported road risky behavior of Spanish students. Methods: For this cross-sectional study, a representative sample of 4062 (51.5% males and 48.5% females) participants attending primary (47.5%), secondary (40.7%), and high school (11.7%) was gathered through a national survey on RSE and road behaviors. Results: A set of significant associations between demographic factors, RSE variables, and self-reported road behaviors was found. Furthermore, Structural Equation Modelling (SEM) allowed us to establish that age and observed misbehaviors (positively), and attitudes towards road safety and risk perception (negatively), have a direct link with the road risky behavior of children and young people. The knowledge of traffic rules was not a significant predictor of road behavior. Conclusions: The results of this study show that, together with demographic factors such as age, RSE-related variables have an effect on the road behavior of children and young people. They also suggest the need for strengthening actions to be implemented in road safety (Road Safety Education) at scholar and community levels.

Oral health behaviour of children and adolescents in Germany. Results of the cross-sectional KiGGS Wave 2 study and trends

Oral health behaviour plays a key role in the prevention of caries and periodontitis. This article describes the prevalence, determinants and trends of tooth brushing frequency and utilization of dental check-ups. The analyses are based on the data from the second wave of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017). The results show that around 80% of children and adolescents meet the recommended tooth brushing frequency and utilization of dental check-ups. Around one fifth of children and adolescents do not meet the recommendations. 14- to 17-year-old adolescents, as well as those with low socioeconomic status and a migration background are groups which are particularly at risk. Compared to the KiGGS baseline study (2003-2006), tooth brushing frequency and utilization of dental check-ups has improved. While this positive development is apparent for nearly all the population groups analysed, the same risk groups that were identified by the baseline study are also evident in the KiGGS Wave 2 results. Targeted measures directed at specific target groups to promote oral health behaviour at younger ages should therefore be maintained and expanded, respectively.

Impact of oral health literacy on self-reported missing data in epidemiological research

OBJECTIVES

To investigate whether oral health literacy (OHL) impacts missing data obtained through self-reporting in oral health epidemiological research.

METHODS

A cross-sectional study was conducted with parents (n = 344) of 4- to 5-year-old children randomly selected from public schools within the city of Curitiba, Brazil. Parental OHL was measured using the Brazilian version of the Rapid Estimate of Adult Literacy in Dentistry (BREALD-30). Parents answered a set of questionnaires comprising 88 items concerning sociodemographic and economic data, children's access to dental services, oral hygiene behaviour, diet and mealtime behaviour. The total number of unanswered items (TUI) and the number of unanswered items in each type of question (open-ended, dichotomous, multiple choice with up to 4 options and with 5-9 options) for each participant was compared across different levels of OHL (chi-squared, Mann-Whitney, Kruskal-Wallis and Spearman's correlation test). Multiple Poisson regression was used to estimate rate ratios (RR) of TUI between OHL scores and their respective 95% confidence interval (95% CI).

RESULTS

Approximately one-third of studied parents (37%) exhibited low OHL (BREALD-30 ≤ 21). The prevalence of missing data in at least one item was 85.5%. Low OHL was associated with failing to respond open-ended items (P = 0.003) and multiple-choice items with up to 4 (P = 0.003) and between 5 and 9 options (P = 0.030). There was a negative correlation between OHL scores and TUI (r = -0.195; P < 0.001), as well as with the number of unanswered items in all types of questions (P < 0.01), except dichotomous questions. Parents with lower OHL were more likely to show higher values of TUI (RR 0.95: 0.93-0.98), when adjusted by income and education.

CONCLUSIONS

Participants with lower OHL were significantly more likely to fail to complete research questionnaires. The impact of OHL on missing data was greater with more complex types of items.

Knowledge of Periodontal Diseases, Oral Hygiene Practices, and Self-Reported Periodontal Problems among Pregnant Women and Postnatal Mothers Attending Reproductive and Child Health Clinics in Rural Zambia

Aim

To determine the level of knowledge of periodontal diseases, practices regarding oral hygiene, and self-perceived periodontal problems among pregnant and postnatal women attending reproductive and child health clinics in rural districts of Zambia.

Methodology

This was a quantitative, questionnaire-based, descriptive, and cross-sectional study that recruited 410 women aged 15 to 43 years. Data were analyzed using SPSS v19.0 computer program.

Results

Participants knowledgeable of periodontal diseases were 62%; gingivitis signs included gum swelling (87.4%) and bleeding (93.3%). Of all participants, 95.6% practiced tooth brushing: twice/day (38.5%), using plastic toothbrush (95.6%), chewing stick (12.2%), toothpick (10.7%), dental floss (2.0%), and tongue cleaning (55.4%). Self-reported periodontal problems were bleeding gums (23.2%), gums that were reddish (10.5%), swollen (11.0%), painful (15.9%), and mobile teeth (3.4%). In logistic regression analysis, painful gums, reddish gums, and toothpick use were 21.9, 4.7, and 4.3 respectively, significantly more likely to cause gum bleeding on tooth brushing.

Conclusions

Most studied women had general knowledge of periodontal diseases but only few knew the cause. All participants performed tooth cleaning; however, majority did not know appropriate practices, and only few had periodontal problems. Integration of oral health to general health promotion and periodontal therapy to pregnant women at high risk is recommended.

Is parental oral health literacy a predictor of children's oral health outcomes? Systematic review of the literature

BACKGROUND

The scientific evidence regarding the association between parental oral health literacy (OHL) and children's oral health is unclear.

AIM

To evaluate the scientific evidence concerning the association between parental OHL and children's oral health outcomes.

DESIGN

Eight databases were searched. Studies that evaluated oral health outcomes among children and measured parental OHL through a validated tool were included. Two independent reviewers selected studies, extracted data and analysed the risk of bias.

RESULTS

Eleven studies were included. Most (n = 6) had a high risk of bias. Most studies evaluating dental caries found association between lower parental OHL and higher prevalence/experience of dental caries. Poor oral health-related quality of life was associated with decreased parental OHL (P < 0.05). Studies diverged on the association between OHL and the number of filled, extracted teeth, and dental visits. There was no association between children's tooth brushing frequency, use of toothpaste, oral health claim, oral health expenditures and parental OHL. The literature was inconclusive regarding the association between night bottle feeding, negative parental perception of the child's oral health and OHL.

CONCLUSION

Low parental OHL was associated with dental caries among their children. It is too soon to assume an association between OHL and the remaining outcomes.

Association of oral health literacy with oral health behaviors, perception, knowledge, and dental treatment related outcomes: a systematic review and meta-analysis

OBJECTIVES

To conduct a systematic review and meta-analysis regarding the association of oral health literacy (OHL) with oral health behaviors, perception, knowledge, and dental treatment related outcomes.

METHODS

Eight electronic databases were searched up until June 2017. Studies regarding the aforementioned outcomes measuring OHL through a validated instrument and in which OHL was an explanatory variable were included. Two independent reviewers selected studies, extracted data, and analyzed the risk of bias of the studies. Meta-analysis using random effect modeling was undertaken. Pooled estimates were calculated with 95 percent confidence interval (CI) and odds ratios (OR).

RESULTS

Twenty-five studies were included in the systematic review and three in the meta-analysis. Most studies were cross-sectional (n = 21) and had a high risk of bias (n = 17). The meta-analysis showed no association between OHL and frequency of visit to the dentist for adults, either through bivariate analysis (OR = 1.25; 95 percent CI: 0.95-1.63) or multivariate analysis (OR = 1.90; 95 percent CI: 0.77-4.84). Dental anxiety and night bottle-feeding were associated with low OHL (P < 0.05). Most studies regarding tooth brushing frequency found no association with OHL. Most studies regarding oral health knowledge related outcomes reported an association with higher OHL. The literature was inconclusive regarding the association between OHL and dental treatment outcomes, oral health behaviors, and oral health perception.

CONCLUSIONS

The current scientific evidence suggests that no association exists between OHL and any of the outcomes investigated. Further prospective studies with a higher methodological quality are necessary to confirm the evidence.

A Dynamic Risk Factors-Based Typology of Sexual Offenders

The purpose of this article was to develop an Spanish psychometric typology of sexual offenders taking into account dynamic risk factors. The sample comprised 94 sex offenders imprisoned in Spain (52 rapists and 42 child molesters). The analysis yielded two different offender categories based on the subjects' criminogenic needs level (high and low). The results also showed that social desirability has a strong influence on the developed typologies, whereas the offence type, sociodemographic characteristics, and criminal history do not. A dynamic risk factors typology, such as the one proposed here, could help criminal and correctional facilities to fulfill their remit. It could also be useful for linking treatment intensity to offenders' criminogenic needs, as well as providing a platform for recidivism risk assessments.

Projecting the impact of hypothetical early life interventions on adiposity in children living in low-income households

It is difficult to evaluate the effectiveness of interventions aimed at reducing early childhood obesity using randomized trials. Objective To illustrate how observational data can be analysed using causal inference methods to estimate the potential impact of behavioural 'interventions' on early childhood adiposity. Methods We used longitudinal data from 1054 children 1-5 years old enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children and followed (WIC) from 2008 to 2010 for a mean duration of 23 months. The data came from a random sample of WIC families living in Los Angeles County in 2008. We used the parametric g-formula to estimate the impact of various hypothetical behavioural interventions. Results Adjusted mean weight-for-height Z score at the end of follow-up was 0.73 (95% CI 0.65, 0.81) under no intervention and 0.63 (95% CI 0.38, 0.87) for all interventions given jointly. Exclusive breastfeeding for 6 months or longer was the most effective intervention [population mean difference = -0.11 (95% CI -0.22, 0.01)]. Other interventions had little or no effect. Conclusions Compared with interventions promoting healthy eating and physical activity behaviours, breastfeeding was more effective in reducing obesity risk in children aged 1-5 years. When carefully applied, causal inference methods may offer viable alternatives to randomized trials in etiologic and evaluation research.

Increasing water intake in pre-school children with unhealthy drinking habits: A year-long controlled longitudinal field experiment assessing the impact of information, water affordance, and social regulation

OBJECTIVE

We investigated the effect of three interventions to increase the plain water consumption of children with unhealthy drinking habits, with an innovative approach combining the three layers of Installation Theory: embodied competences, affordances and social regulation.

METHODS

334 preschool children and their carers were allocated to three interventions: Control (control): no intervention, Information (info): online coaching sessions on water health benefits aiming at modifying embodied competences (knowledge), Information + Water Affordance (info + w): the same plus home delivery of small bottles of water. After three months, half of the info and info + w subjects were allocated to Social Regulation (+social) (on-line discussion forum) or no further intervention (-social). Intake of plain water and all other fluid types of the children were recorded by the carers 6 times over a year using an online 7-day fluid-specific dietary record.

RESULTS

Over 1 year, all groups significantly increased daily water consumption by 3.0-7.8 times (+118 to +222 mL). Info + w + social and Info-social generated the highest increase in plain water intake after one year compared to baseline, by 7.8 times (+216 mL) and 6.7 times (+222 mL) respectively; both significantly exceeded the control (3.0 times, +118 mL), whilst the effect of info + w-social (5.0 times, +158 mL) and info + social (5.3 times, +198 mL) did not differ from that of control. All groups saw a decrease of sweetened beverages intake, again with info + w + social generating the largest decrease (-27%; -172 mL). No changes in other fluids or total fluid intake were observed.

CONCLUSIONS

Sustainable increased water consumption can be achieved in children with unhealthy drinking habits by influencing representations, changing material affordances, and providing social regulation. Combining the three provided the strongest effect as predicted by Installation Theory.

Mechanisms Linking Interparental Aggression to Child Dental Caries

Research has garnered support for a systemic view of factors affecting child dental caries that accounts for the influence of social factors such as the family environment. Our previous work has demonstrated the association between mother-to-father emotional aggression and child caries. The present study builds on these results by evaluating pathways that might explain this relation. Families (n = 135) completed a multimethod assessment of mother-to-father emotional aggression, child caries, and several hypothesized mediators (i.e., child cariogenic snack and drink intake, child internalizing behaviors, child salivary cortisol and α-amylase reactivity, parental laxness, child oral hygiene maintenance, and parental socialization of child oral hygiene maintenance). Mediation analyses partially supported the role of the child's diet as a mechanism linking mother-to-father emotional aggression and child caries. However, children's neglect of oral hygiene, parental laxness, and child emotional and biological disturbances failed to stand as conduits for this association. Future investigations should expand upon these results to better establish the causal links that could only be suggested by the present cross-sectional findings.

The effect of motivational interviewing on oral healthcare knowledge, attitudes and behaviour of parents and caregivers of preschool children: an exploratory cluster randomised controlled study

Background

Motivational Interviewing (MI) has been used across primary healthcare and been shown to be effective in reducing the prevalence of early childhood caries (ECC) in preschool children. This study aimed to compare the effect of MI, in contrast to traditional dental health education (DHE), on oral health knowledge, attitudes, beliefs and behaviours among parents and caregivers of preschool children in Trinidad.

Method

The design of this exploratory study included a cluster randomised controlled trial and semi-structured focus groups. Six preschools (79 parents and caregivers) in Eastern Trinidad were randomly assigned to a test or control group (3 preschools in each group). Parents and caregivers in the test-group (n = 25) received a talk on dental health using an MI approach and the control-group (n = 54) received a talk using traditional DHE. Both groups received additional, written dental health information. The MI group also received two telephone call follow-ups as part of the MI protocol. Both groups were given questionnaires before the talks and four months later. Question items included oral health knowledge, beliefs, attitudes, brushing behaviour, oral health self-efficacy, oral health fatalism and a specific instrument to asses ‘readiness for change’, the Readiness Assessment of Parents Concerning Infant Dental Decay (RAPIDD). Participants in the test-group were also invited to take part in a focus group to share their views on the dental health talk.

Results

At four month follow-up, knowledge items on fluoride use, tooth brushing, dietary practice and dental attendance increased in both the test (DHE + MI) and control (DHE) groups ((p < 0.05, Chi Square test). In the test-group there were increases in mean child tooth brushing frequency and reduction in oral health fatalism (p < 0.05 t-test). Findings from a thematic analysis of the focus group suggested that the MI talk and telephone follow-up were well accepted and helpful in supporting parent and caregiver efforts to improve oral health practices for their preschool children.

Conclusion

In this exploratory controlled study there was some evidence that using an MI approach when delivering oral health information had a positive effect on parent/ caregiver oral health knowledge, attitudes and behaviours compared to traditional DHE. There is need for further research involving the use of brief-counselling techniques in this Caribbean population.

How Well Is CHIP Addressing Oral Health Care Needs and Access for Children?

OBJECTIVE

We examine how access to and use of oral and dental care under the Children's Health Insurance Program (CHIP) compared to private coverage and being uninsured in 10 states.

METHODS

We report on findings drawn from a 2012 survey of CHIP enrollees in 10 states. We examined a range of parent-reported dental care access and use measures among CHIP enrollees. Comparisons of the experiences of established CHIP enrollees to the experiences of newly enrolling children who had been uninsured or privately insured were used to estimate the impacts of CHIP on children's oral health and dental care.

RESULTS

Most children enrolled in CHIP had a usual source of dental care and had received a dental checkup or cleaning in the past year, and most over age 6 had had sealants placed on their molars. In addition, parents of most CHIP enrollees were aware that CHIP covered dental benefits, and most reported not having trouble finding a dentist to see their child. Even so, 12% of CHIP enrollees had unmet dental care needs. Compared to being uninsured, CHIP enrollees did better across nearly all oral health measures. Compared to being privately insured, CHIP enrollees were more likely to have dental benefits, to have a usual source of dental care, and to have had a dental checkup/cleaning, but they were more likely to have trouble finding a dentist and less likely to say that their child's teeth were in excellent/very good condition.

CONCLUSIONS

Enrolling eligible uninsured children in CHIP led to improvements in their access to preventive dental care, as well as reductions in their unmet dental care needs, yet the CHIP program has more work to do to address the oral health problems of children.

Evaluation of tuberculosis infection control measures implemented at primary health care facilities in Kwazulu-Natal province of South Africa

Background

Tuberculosis (TB) is a global public health concern. It is even more so as its incidence seems to be increasing in South Africa. The aim of this study was to describe and compare the tuberculosis infection control measures implemented by facilities in Ugu and Uthungulu health districts of Kwazulu-Natal province.

Methods

This was a cross-sectional survey based on a self-administered questionnaire and site visit observations. Data were collected from healthcare workers at 52 health facilities from the beginning of February to mid-March 2012. The facilities that completed the questionnaires were visited for site observations.

Results

The mean age of participants was 44.7 ± 11.7 years of age, ranging from 22 to 66 years old; 89.1% of them were females and nurses. Overall, some 48.6% (18 out of 37) of aspects of tuberculosis infection control encompassing administrative, environmental, clinical and occupational health measures were complied with by at least 80% of facilities surveyed. The unfortunate outcome of this inadequate compliance was that 23 and 12 cases of nosocomial tuberculosis had been diagnosed among staff members respectively in Ugu and Uthungulu districts.

Conclusions

Overall, it appears that at the facilities surveyed, less than 50% of tuberculosis infection control measures were complied with. This finding calls for appropriate interventions to be designed and implemented. These include the purchase and installation of environmental control systems; the implementation of administrative tuberculosis infection control measures at each facility together with the training of staff members on the strict adherence to preventive measures including the use of personal protective equipment.

Social determinants of denture/bridge use: Japan gerontological evaluation study project cross-sectional study in older Japanese

Background

Studies suggest that using a denture/bridge may prevent disability in older people. However, not all older people with few remaining teeth use a denture/bridge. This cross-sectional study aimed to examine the social determinants which promote denture/bridge use among older Japanese.

Methods

A total of 54,388 (25,630 males and 28,758 females) community-dwelling individuals aged 65 or over, living independently, able to perform daily activities, and with 19 or fewer teeth. The dependent variable was denture/bridge use. Socio-demographics, number of teeth, present illness, social participation, social support, and social networks were used as individual-level independent variables. Data for social capital were aggregated and used as local district (n = 561 for males, n = 562 for females) -level independent variables. Number of dentists working in hospitals/clinics per population and population density were used as municipality (n = 28) -level independent variables. Three-level multilevel Poisson regression analysis was performed for each sex.

Results

High equivalent income, low number of teeth, present illness, and living in a municipality with high population density were significantly associated with denture/bridge use in both sexes in the fully adjusted models (p < 0.05). Denture/bridge use was significantly associated with high educational attainment in males and participating in social groups in females in the fully adjusted model (p < 0.05). No significant associations were observed between denture/bridge use and social capital.

Conclusions

Denture/bridge use was significantly associated with high economic status and present illness in both sexes, high educational attainment in males, and participation in social groups in females among community-dwelling older Japanese after adjusting for possible confounders.

Influence of caregivers and children's entry into the dental care system

OBJECTIVES

Early preventive dental visits are essential in improving children's oral health, especially young children at high risk for dental caries. However, there is scant information on how these children enter the dental care system. Our objectives were as follows: (1) to describe how a population-based cohort of young Medicaid-enrolled children entered dental care; and (2) to investigate the influence of caregiver characteristics on their children's dental care-seeking patterns.

METHODS

We relied on Medicaid claims and interview data of caregiver-child dyads who were enrolled in the Carolina Oral Health Literacy study during 2007-2008. The analytical cohort comprised 1000 children who had no dental visits before enrollment. Additional information was collected on sociodemographic characteristics, oral health status, health literacy, dental neglect, and access to care barriers. Our analyses relied on descriptive, bivariate, and multivariate methods.

RESULTS

During the 25-month median follow-up period, 39% of the children (mean baseline age: 16 months) entered the dental care system, and 13% of their first encounters were for emergency care. Caregivers' dental neglect emerged as a significant predictor of nonentrance. Children with reported oral health problems at baseline were more likely to enter the dental care system compared with children with better oral health, but they were also more likely to require emergency care.

CONCLUSIONS

Caregivers have a pivotal role in children's oral health and care. Interventions aimed at improving children's oral health should involve community outreach to engage caregivers in a culturally appropriate manner when their children are infants or toddlers.

CT-optimized skin stroking delivered by hand or robot is comparable

Introduction: The aim of our study was to investigate whether a pleasant tactile stimulation which is manually produced is qualitatively comparable to an analogous tactile stimulation produced instead by a mechanical source.

Methods: Thirty-one subjects [16 men, 15 women, 24.5 ± 2.6 years, mean, and standard deviation (SD)] were tested under four different conditions in a repeated measurements design. A pleasant caress-like brush stroke on the hairy skin of the forearm was either produced by a robot or by hand with three different velocities (0.3, 3, and 30 cm/s). In two conditions the subjects were informed about the stroke's source, whereas in two different conditions they were not. Subsequent to the stimulation, the subjects were asked to rate both pleasantness and intensity of each tactile sensation.

Results: Consistently, pleasantness ratings were very similar in both conditions. This was found across stimulus velocities and regardless of whether the subjects were informed about the source of the on-going stroke or not. In contrast, intensity ratings were significantly higher in the handheld condition for the two slower velocities, but not for the fastest one.

Conclusion: As robot and human touch are highly comparable in terms of perceived pleasantness, handheld stimulation may be used in studies of touch hedonia where robot stimulation is not applicable (for instance in children or certain body parts).