Socio-behavioural aspects in the prevention and control of dental caries and periodontal diseases at an individual and population level

Dental professionals' views on motivational interviewing for the prevention of dental caries with adolescents in central Norway

BACKGROUND

Establishing positive oral health behaviours during adolescence should be a key priority to improve lifelong oral health. However, changing adolescent behaviours is known to be a challenge. Motivational interviewing (MI) is a method of working with patients to activate their motivation for change and has shown promising results within the dental setting. Yet, little is known about the actual experiences and perspectives of Norwegian dental health professionals in delivering motivational interviewing as part of routine care to their young patients. The overall aim of the present study was to explore the implementation of motivational interviewing by dentists and dental hygienists, employed by the Norwegian Public Dental Service, for their adolescent patients.

METHODS

As part of the larger #Care4YoungTeeth <3 project, a Norwegian Research Council funded four-year Collaborative Project to Meet Societal and Industry-related Challenges, an online survey was developed and administered to dental personnel (n = 168) in one region of Central Norway. Data were analysed by descriptive statistics and two-sample tests of proportions at the 95% confidence level.

RESULTS

A total of 98 dental personnel responded to the survey (response rate 58.3%), of which 37 were dental hygienists (response rate 72.5%) and 61 were dentists (response rate 52.1%). A greater proportion of hygienists reported implementing this intervention compared to dentists (78.4% versus 50.8%; p = 0.007). Similarly, a greater proportion of hygienists (83.8%) stated that they had received training in MI compared to dentists (65.6%; p = 0.051). About 80% of dentists and 90% of dental hygienists felt that they understood the principles of MI. However, only about 45% and 60%, respectively, felt confident in its use. Dental hygienists found MI more usable in their work (p = 0.052), to a greater extent want to use MI (p = 0.002) and found that using MI works well (p < 0.001), as compared to dentists.

CONCLUSIONS

A high proportion of dental professionals working within a Norwegian public dental service have received training in MI. However, barriers to implementation for adolescent patients and differences in practice between dentists and hygienists warrant further enquiry.

Assessment of oral health status and related factors in adolescents aged 12-15 years in the Gansu Province of China: a cross-sectional survey

BACKGROUND

The national oral epidemiological survey conducted every decade has become an indispensable means of detecting changes in oral disease patterns. This study was undertaken to investigate the oral health status and related factors in 12-15-year-old students in Gansu, China.

METHODS

According to the methodology adopted by the Fourth National Oral Health Survey, a multi-stage, stratified, random sampling method was used to select 3871 adolescents aged 12-15 years from four regions of Gansu Province for oral examination and questionnaire survey. Caries experience was measured using the Decayed, Missing, and Filled Teeth (DMFT) index; and periodontal health examination included gingival bleeding, calculus, periodontal pockets and attachment loss. The questionnaire included questions regarding sociodemographic characteristics, and oral health knowledge and behaviors. SPSS20.0 software was used for statistical analysis of the survey data.

RESULTS

The mean DMFT index was 0.83 ± 1.42. The prevalence of caries experience was 38.6%, filling rate was 1.6%, and pit and fissure sealing rate was 0.5%. Logistic regression analysis showed that female sex, rural district, older age, non-only child, frequency of dental visits, and toothache experience were the risk factors for caries experience, with OR ranging between 1.280 and 3.831 (p < 0.05). Prevalence of healthy periodontium was 29.8%. Female sex, rural district, and younger age were found to be the protective factors for healthy periodontium, with OR ranging between 1.178 and 1.414 (p < 0.05).

CONCLUSIONS

Adolescents in Gansu Province had high prevalence of caries experience along with low filling rate, and low prevalence of healthy periodontium. Therefore, it is necessary to vigorously strengthen oral health education, disease prevention and control programs in the province. This would help improve the oral health-related quality of life of these individuals.

Periodontal status of students living with disability in Amhara region, Ethiopia: a cross-sectional study

Background

Periodontal disease is the most common oral health problem among individuals living with disabilities. Any physical impairment and/or mental handicap can compromise the capability to perform oral health care. Individuals with poor oral hygiene practice were prone to dental caries, periodontal disease, and upper respiratory tract infections. Despite the high prevalence of disabled people in Ethiopia, data are scarce about their periodontal status. The aim of this study was to determine the prevalence and determinant factors of periodontal disease among students living with disability in the Amhara region.

Methods

A school-based cross-sectional study was done on eight special needs schools in Amhara regional state from November 30, 2020, to April 10, 2021. A simple random sampling technique using a computer random generator was employed to recruit the study participants. The participants were interviewed for sociodemographic characteristics, oral hygiene practice, type of disability, and medical condition through a pre-tested semi-structured questionnaire. The periodontal status of the participants was evaluated using the community periodontal index (CPI). Data entry was done using the Epi-data and analyzed using SPSS 26. Binary logistic regression analysis was used to identify the predictors of periodontal disease at a 5% level of significance.

Results

A total of 443 study participants were involved with a mean age of 15.84 ± 3.882. Among these, 27.5% (95%CI 23.4–32.0) had a periodontal pocket depth of ≥ 4 mm, and 56.7% had bleeding on probing. The prevalence of periodontal disease was higher in participants with poor oral health status (52.2%), dental caries (34.8%), class-2 malocclusion (46.1%), and low monthly income (30.4%), visually impaired (30%), and mentally disorder (29.9%). Age of above 18 years (AOR = 3.41, 95%CI 1.40, 8.28), low family monthly income (AOR = 2.21; 95%CI 1.22, 4.03), malocclusion (AOR = 1.59, 95%CI 1.01, 2.54), poor oral health status (AOR = 9.41; 95%CI 4.92, 17.98), and dental caries (AOR = 1.85, 95%CI 1.21, 2.82) were independent predictors of periodontal disease.

Conclusions

A substantial amount of disabled school students in the study area had periodontal disease. The study found that there was a statistically significant association between age, family monthly income, malocclusion, oral health status, and dental caries with periodontal disease. The implementation of school oral health programs has a great benefit for the oral health status of disabled school students.

A Narrative Review on Current Diagnostic Imaging Tools for Dentomaxillofacial Abnormalities in Children

The current review narrates the findings and discusses the available diagnostic tools for detecting structural abnormalities. The review discusses several diagnostic tools, such as magnetic resonance imaging, cone beam computed tomography, multi detector row CT and positron emission tomography. The vital findings and comparative analysis of different diagnostic tools are presented in this review. The present review also discusses the advent of newer technologies, such as the HyperionX9 scanner with less field of view and 18F-FDG PET/CT (positron emission tomography with 2-deoxy-2-[fluorine-18] fluoro-D-glucose, integrated with computed tomography), which can give more efficient imaging of dentomaxillofacial structures. The discussion of effective comparative points enables this review to reveal the available diagnostic tools that can be used in the detection of dentomaxillofacial abnormalities in the pediatric population. The advantages and disadvantages of each tool are discussed, and the findings of past publications are also presented. Overall, this review discusses the technical details and provides a comparative analysis of updated diagnostic techniques for dentomaxillofacial diagnosis.

Oral Health-Related Knowledge, Attitudes and Behaviours of Arab Dental Students: Multi-National Cross-Sectional Study and Literature Analysis 2000-2020

Dental students are the future leaders of oral health in their respective communities; therefore, their oral health-related attitudes and behaviours are of practical value for primary disease prevention. The present study aimed to evaluate oral health-related knowledge, attitudes, and behaviours of dental students in Arab countries and explore the potential sociodemographic predictors of their oral health outcomes. A multi-centre, cross-sectional study was conducted during the academic year 2019/2020 in three Arab countries: Lebanon, Syria, and Tunisia. The study used a validated Arabic version of the Hiroshima University Dental Behavioural Inventory (HU-DBI) composed of original twenty items that assess the level of oral health-related knowledge, attitudes, and behaviours, and four additional dichotomous items related to tobacco smoking, alcohol drinking, problematic internet use, and regular dental check-up The HU-DBI score ranges between 0 and 12. A total of 1430 students took part in this study, out of which 60.8% were females, 57.8% were enrolled in clinical years, 24.5% were tobacco smokers, 7.2% were alcohol drinkers, and 87% reported internet addiction. The mean HU-DBI score was 6.31 ± 1.84, with Lebanon having the highest score (6.67 ± 1.83), followed by Syria (6.38 ± 1.83) and Tunisia (6.05 ± 1.83). Clinical students (6.78 ± 1.70) had higher HU-DBI scores than their preclinical peers (5.97 ± 1.86). The year-over-year analysis revealed that dental public health and preventive dentistry courses had significantly and positively impacted the undergraduate students’ knowledge, attitudes, and behaviours. The gender-based differences were not statistically significant, with a modest trend favouring males, especially oral health behaviours. Tobacco smoking, alcohol drinking, and problematic internet use were associated with lower HU-DBI scores. In the Arab world, the economic rank of the country where the dental students live/study was weakly correlated with the students’ mean HU-DBI score.

The effectiveness of behaviour change interventions delivered by non-dental health workers in promoting children’s oral health: A systematic review and meta-analysis

Objectives

Dental caries is the most common preventable childhood condition. Non-dental professionals and health workers are often well placed to support parents in adopting positive oral health behaviours for their children. The aim of this study was to determine the effectiveness of behaviour change interventions and their individual component behaviour change techniques (BCTs), that were delivered by non-dental professionals and health workers.

Methods

A systematic search of Ovid MEDLINE, PubMed, CINAHL, Cochrane Library, Web of Science, TRoPHI and PROQUEST from inception until March 2021 was conducted. Randomised controlled trials and quasi-experimental studies for improving oral health outcomes in children were included. Quality assessment was carried out using Cochrane Risk of Bias tool and ROBINS-I tool. Publication bias was assessed using funnel plots and Egger’s regression intercept. Effect sizes were estimated as standardised mean difference (SMD) and odds ratio/risk ratio for proportions. Meta-analyses were performed for studies reporting mean decayed, missing, filled surfaces (dmfs) and mean decayed, missing, filled, teeth (dmft) indices. Behaviour change technique coding was performed using behaviour change technique taxonomy v1 (BCTTv1).

Results

Out of the 9,101 records retrieved, 36 studies were included with 28 showing a significant effect either in clinical and/or behavioural/knowledge outcomes. Most studies (n = 21) were of poor methodological quality. The pooled SMD for caries experience showed statistically significant result for caries prevention at surface level -0.15 (95% CI -0.25, -0.04) and at the tooth level -0.24 (95% CI -0.42, -0.07). In 28 effective interventions, 27 individual BCTs were identified and the most frequently used were: “Instructions on how to perform the behaviour” and “Information about health consequences”.

Conclusion

There is low quality of evidence suggesting non-dental professionals and health workers may help improve oral health outcomes for children. To confirm these findings, further high-quality studies incorporating a variety of BCTs in their interventions for adoption of good oral health behaviours are needed.

Beyond oral hygiene, are capacity-altering, biologically based interventions within the moral domain of dentistry?

Oral diseases such as dental caries (DC) and periodontitis are widely prevalent, and existing approaches to managing these conditions have only a limited effect. Accordingly, there is growing interest in the development of novel biological interventions (including, among others, CRISPR-Cas9) that might, in the future, be used to prevent the development of or cure these conditions. However, in addition to familiar concerns about using biological interventions in children who cannot provide valid consent, it is not clear whether the provision of these interventions would fall within the proper domain of dentistry. In this opinion paper, we defend the view that the provision of reasonably safe and effective novel biological interventions aimed at preventing DC and periodontitis should be understood to fall within the proper domain of dentistry. To do so, we first argue that their use would be consistent with existing practice in dentistry. We then argue that: i) they may substantially increase the recipient's wellbeing and future autonomy; and ii) that their use could constitute a form of indirect preventative medicine by addressing a threat to systemic health.

The role of mechanical control of biofilm in the salivary pH after sucrose exposure in children with early childhood caries

This quasi-experimental study sought to investigate if the mechanical control of biofilm (3-times-a-day) modifies the saliva’s ability to buffer the oral environment after 20% sucrose rinse (SR_20%) in children with early childhood caries (ECC). Here, SR_20% reduced the saliva’s pH in both groups and the mechanical control of biofilm had a greater effect on this parameter after SR_20% in CF children. The mechanical control of biofilm evidenced a higher buffering capacity in CF children before SR_20%, which was not observed after SR_20%. Otherwise, the absence of mechanical control of biofilm showed that buffering capacity was comparable in the two groups before SR_20%, whereas after SR_20% the saliva’s buffering capacity of CF children was higher than ECC children. When biofilm was mechanically controlled, carbonic anhydrase VI activity did not change after SR_20% whereas the absence of mechanical control of biofilm reduced this enzyme activity after SR_20%. In conclusion, the mechanical control of biofilm did not change saliva’s ability to buffer the oral environment after SR_20% in children with ECC. On the other hand, CF children appeared to regulate more effectively the saliva’s pH than ECC children while the absence of mechanical control of biofilm mediated their pH-modifying ability after SR_20%.

Motivational interviewing for preventing early childhood caries: A systematic review and meta-analysis

OBJECTIVES

This systematic review with meta-analysis was performed to assess whether motivational interviewing (MI) is effective in the prevention of early childhood caries (ECC) and to examine potential sources of heterogeneity.

METHODS

Interventions based on motivational interviewing were considered eligible. The main outcome was new caries lesions (some studies included white-spot lesions in total count), and secondary outcomes included caregivers' oral health knowledge, home-care behaviours, plaque index, gingival index and fluoride varnish applications. Controls were any type of oral health education or negative controls without any specific intervention.

RESULTS

From a total of 1498 studies identified in the databases search, 1078 were assessed for eligibility by reading titles and abstracts, after removal of duplicates. Full-text screening was performed in 61 articles, with 18 reporting on 14 different studies included in the qualitative synthesis and 8 in the quantitative synthesis (four studies included new white-spot lesions in total count). Subgroup analysis was performed by the control group dmft/dmfs and the test for subgroup differences suggests that there is a subgroup effect (P = .06), so population caries experience modifies the effect of MI-based intervention. In populations with high caries experience, the MI-based approach proved preventing an average of 3.15 (95% CI: -6.14, -0.17) dmfs in young children. In samples with low caries experience, differences were smaller, since the caries levels were already lower (-0.31; 95% CI: -0.63, 0.00).

CONCLUSION

Motivational interviewing has the potential to modify knowledge and behaviours and reduce ECC with a more significant impact on children with high caries experience.

The effect of a behavioural management tool in adults with mild to moderate periodontitis. A single-blind, randomized controlled trial

OBJECTIVE

To compare a behavioural management program (test) to a standard communication approach (control) to reduce plaque, improve clinical outcomes and patient's compliance with oral self-care.

BACKGROUND

Since psychological factors affect oral health-related behaviours, approaches directed at changing behaviours and improving compliance might improve the effect of oral health education.

MATERIALS AND METHODS

This was a randomized, single-blind, parallel-design trial involving 71 patients with mild to moderate periodontitis. During a run-in period, all participants began using a power toothbrush. Two sessions of non-surgical periodontal therapy were performed post-baseline, along with one of the two oral healthcare communication approaches. Plaque and bleeding scores, probing pocket depth (PPD) and clinical attachment level (CAL) were recorded at the screening visit, baseline visit and at 8 and 14 weeks post-baseline. Patients were asked to fill in oral self-care diaries. Experience questionnaires were administered to both clinicians and patients to assess subjective experience of the clinician-patient interactions during the visits.

RESULTS

In both groups, a significant reduction in plaque and bleeding scores was observed from baseline to 8 weeks after baseline, which then remained stable at week 14, but no differences between the groups were noted. An improvement in CAL and PPD was recorded at week 8 post-baseline in the test compared to the control group. No inter-group differences in the clinician's and subject's experience questionnaires were observed.

CONCLUSION

Both approaches significantly promoted periodontal health. However, changing lifestyle requires repeated communication/engagement over time and a behavioural management program based upon two visits did not provide additional benefit compared to a standard approach.

Relations between periodontal status, oral health-related quality of life and perceived oral health and oral health consciousness levels in a Turkish population

OBJECTIVES

This study aimed to evaluate the interrelationship of periodontal status, socio-demographic characteristics, perceived oral health and oral health consciousness levels as well as the impact of these factors on quality of life using a questionnaire and the Oral Health Impact Profile-14(OHIP-14) scale.

METHODS

Seven hundred and fifty systemically healthy individuals aged ≥18 years referred to a Periodontology Department were included in the study. The OHIP-14 scale and survey were applied to identify socio-demographic characteristics, oral hygiene characteristics, perceived oral health and oral hygiene consciousness levels. Three groups were established based on periodontal status (periodontally healthy [H], gingivitis [G] and periodontitis [P]) determined using periodontal indexes, and the relationship between the above-mentioned factors and periodontal status with quality of life was assessed.

RESULTS

Oral health-related quality of life differed significantly by gender, marital status, education level, oral hygiene habits and periodontal status. A statistically significant positive relationship was found between high OHIP-14 scores and unfavourable socio-demographic characteristics, increased severity of periodontal disease, and irregular dental care practices. The perceived oral health and oral health consciousness levels significantly differed due to periodontal status.

CONCLUSION

Periodontal status, gender, marital status, education level, dental care practices, perceived oral health and oral hygiene consciousness levels are important determinants of oral health-related quality of life (Clinical Trial No. NCT03549247).

Dental caries is associated with severe periodontitis in Chilean adults: a cross-sectional study

BACKGROUND

The co-occurrence of caries and periodontitis and a possible association is still a matter of debate. Thus, the aim of the study was to determine the co-occurrence of caries and periodontitis in Chilean adults.

METHODS

Evaluation of periodontal and dental status in 994 adults (35-44 years old) based on the First Chilean National Examination Survey 2007-2008. The prevalence of caries was defined as the percentage of participants with one or more teeth with untreated caries by using the D component of the DMFT index (DT ≠ 0). The prevalence of periodontitis was determined using standard case definitions for population-based surveillance of periodontitis described by the CDC-AAP.

RESULTS

Individuals with caries had an approximately 40% higher prevalence of severe (29.3% vs 20.8%, p < 0.05) and a 13% higher prevalence of total periodontitis (89.3% vs 78.4%, p < 0.05) than those without caries. Ordinal logistic regression revealed a positive association between periodontitis and the number of teeth with caries (DT ≠ 0; 3 or 4 teeth with caries: OR 1.74; CI = 1.12-2.29 p < 0.05; 5 or more teeth with caries: OR 2.47; CI = 1.66-3.67 p < 0.01).

CONCLUSION

Dental caries is associated with the severity and prevalence of periodontitis in Chilean adults. Individuals with 3 or more teeth with untreated caries are more likely to suffer from periodontal disease.