Dental students' perceptions of simultaneous live and online OSCEs during the COVID-19 pandemic

INTRODUCTION

The Objective Structured Clinical Examination (OSCE) is a valid, reliable and reproducible assessment method traditionally carried out as a live examination but recently also provided online. The aim was to compare any differences in the perceptions of dental students participating in online and live OSCE using mixed methods.

MATERIALS AND METHODS

All Finnish fourth-year undergraduate dental students (n = 172) attended the exam in April 2021. Due to the COVID-19 pandemic, the official administrative restrictions in teaching in universities still existed in April 2021. By the time of the national OSCE, the pandemic situation varied in different parts of the country. Therefore, two of the universities conducted a live OSCE and two an online version of the OSCE. Data were collected after the OSCE using a voluntary anonymous electronic questionnaire with multiple-choice and open-ended questions (response rate 58%). Differences between the OSCE versions were analysed using the Mann-Whitney U test and open answers with qualitative content analysis.

RESULTS

The students considered both types of OSCE good in general. The main differences were found concerned adequate time allocation and overall technical implementation, in favour of the live OSCE. While a qualitative analysis revealed exam anxiety as the most often mentioned negative issue, overall, comments were positive.

CONCLUSION

Variation in the assessments between different question entities seemed to be wider than between the implemented OSCE versions. Time management in the OSCE should be further developed by managing the assignment of tasks.

Associations of sensory sensitivity, pain catastrophizing, and alexithymia with dental anxiety

We aimed to reveal interrelationships between alexithymia, catastrophic thinking, sensory processing patterns, and dental anxiety among 460 participants who were registrants of a Japanese research company. Measures used were the Modified Dental Anxiety Scale, the Adult Sensory Profile, the Pain Catastrophizing Scale, and the 20-item Toronto Alexithymia Scale. The interrelationships among the constructs were analyzed using structural equation modeling, adjusting for age, gender, and negative dental treatment experience. Data from 428 participants were used in the analyses. Sensory sensitivity and pain catastrophizing were independently associated with anticipatory and treatment-related dental anxiety, while difficulty identifying feelings was not. In the mediation model, sensory sensitivity and pain catastrophizing served as full mediators between difficulty identifying feelings and the dimensions of dental anxiety (indirect effects were between 0.13 and 0.15). The strength of the associations was 0.55 from difficulty identifying feelings to both pain catastrophizing and sensory sensitivity, and between 0.24 and 0.26 to anticipatory and treatment-related dental anxiety. The association between trait-like phenomena, such as alexithymia, and dental anxiety may be mediated by neurophysiological and cognitive factors such as sensory sensitivity and pain catastrophizing. These findings could be crucial for new and innovative interventions for managing dental anxiety.

Autonomic Nervous System Activity and Dental Anxiety in the Northern Finland Birth Cohort (NFBC1966) Population

Autonomic nervous system (ANS) activity may be associated with dental anxiety; however, no studies exist on the topic. The aim of this study was to assess if ANS activity and dental anxiety are associated. Data were collected as part of a Northern Finland Birth Cohort Study, NFBC1966, at the age of 46 years with eligible data on 1905 participants. Dental anxiety was measured using the Modified Dental Anxiety Scale (MDAS) categorized as follows: 19-25 = high, 10-18 = moderate, 5-9 = no to low dental anxiety. Heart rate variability (HRV) data were collected using an HR monitor and a standard lead-II electrocardiogram (ECG). Baroreflex sensitivity (BRS) was calculated from continuous ECG and blood pressure signals. Participants were categorized into three groups as follows: Low = the lowest 20th percentile, Mid = medium 21-79th percentile, and High = the highest 20th percentile according to their ANS variables. The associations between the MDAS and ANS activity parameters were evaluated using unordered multinomial logit models adjusted for comorbidities, β-blockers, BMI, smoking, and education. High heart rate, reduced HRV, low cardiac vagal modulation, and poor BRS were associated with moderate dental anxiety, and high cardiac vagal modulation and good BRS were associated with no to low dental anxiety. Poorer ANS activity might predispose some to dental anxiety, and better ANS activity might protect from dental anxiety.

Two-Year Trajectories of Dental Anxiety in Parents and Their Association with Parents' and Children's Oral Healthcare Procedures in FinnBrain Birth Cohort Study

We aimed to identify parents' dental anxiety trajectories and the association of the trajectories with the number of parents' and their children's oral healthcare procedures in the FinnBrain Birth Cohort Study. Dental anxiety was measured with the Modified Dental Anxiety Scale at gestational weeks (gw) 14 and 34, as well as 3 and 24 months (mo) after childbirth. Oral healthcare procedures from gw14 to 24 mo were obtained from the national patient data register and categorized as preventive and treatment. Trajectories were identified with latent growth mixture modelling for 2068 fathers and 3201 mothers. Associations between trajectories and procedures adjusted for education were analyzed using unordered multinomial logit models. Fathers' trajectories were stable low (80.1%), stable high (3.4%), stable moderate (11.0%), moderate increasing (3.9%) and high decreasing (1.6%). Mothers' trajectories were stable low (80.7%), stable high (11.2%), moderate increasing (5.3%) and high decreasing (2.8%). Mothers with decreasing dental anxiety had a higher number of preventive and treatment procedures. Fathers with decreasing dental anxiety had a higher number of preventive and treatment procedures, while fathers with increasing dental anxiety had fewer procedures. Children of mothers with stable low dental anxiety had higher number of preventive procedures. There seems to be a two-way association between dental anxiety trajectories and oral healthcare procedures.

Intercorporeal Formations in Pediatric Dental Encounters With Patients Showing Distress: The Intertwine of Controlling and Comforting Touch

Dental fear and anxiety are highly prevalent among children and have been shown to lead to irregular use of dental services. Previous research has suggested that while touch can alleviate the patient's stress and help in accomplishing dental procedures, it can also be a source of stress or used to restrain the patient. In this study, we explore the emergence and intertwine of controlling and comforting touch in pediatric dental clinic settings in which patients show signs of resistance, distress, or fear. We use microanalysis of video-recorded interactions to unveil how the adults in the room-any combination of the dentist, dental assistant, hygienist, and caregiver(s)-deploy various types of touch on the child patient to perform the dental procedure while simultaneously comforting the child. Our data set covers video-recordings of naturally occurring dental clinic visits of 3- to 12-year-old child patients from four cultural contexts: Finland, China, Iraq, and the United States. Drawing on Merleau-Ponty's writings on intercorporeality and the interaffectivity of bodies, the study proposes that touch in pediatric dentistry unfolds as complex intercorporeal formations where the interaffectivity emerges not only through touch but also via vocal resonance. In contrast to clear boundaries between comforting and controlling touch, our analysis indicates that the line between comforting and controlling touch can be blurred. We suggest that touching a pediatric patient showing resistance toward a dental procedure requires careful affective attention to the patient's subtle and moment-by-moment bodily expressions and reactions to the touch.

Concordance of Fathers and Mothers in the Assessment of Their 5-Year-Old Child's Dental Fear

The aim of this study was to evaluate the concordance of parents' assessments of their child's dental fear. Cross-sectional secondary analysis used data from the multidisciplinary FinnBrain Birth Cohort Study. Child dental fear was assessed at age 5 with the Finnish translation of the modified Children's Fear Survey Schedule Dental Subscale (CFSS-M) by both fathers (n = 588) and mothers (n = 1100). Reply alternatives were from 1 = not afraid to 5 = very afraid and 6 = no experience coded as missing and 1. In total, 514 mother-father pairs were eligible for the analyses. Descriptive statistics, percentage agreement and Cohen's Kappa coefficients were used in the analyses. The concordance of parents' assessments was poor (Kappa range 0.072-0.258). The majority of parents replied "No Experience" to items related to invasive treatment or being unable to breathe. Thus, coding of this reply alternative had a significant impact on the mean values of the child's fear. When assessing the fear of a five-year-old child, it might not be safe to rely only on one parent's assessment, and whether or not the child has experience with the question asked should also be considered.

The use of dental anxiety management techniques during one-session treatment: a study on five video-recorded patient cases

OBJECTIVE

The aim was to examine what kinds of dental anxiety management techniques dentists use in the context of one-session treatment.

MATERIAL AND METHODS

The data consisted of videotaped treatment sessions for five dentally anxious adults. The treatment was conducted by two experienced dentists without formal training in the treatment of dentally anxious patients or behavioral management techniques. Theory-driven qualitative content analysis, based on the anxiety management classification of Milgrom et al. was used to identify and classify the techniques used during the treatments.

RESULTS

Altogether, diverse categories of dental anxiety management techniques were identified under the main themes of enhancing trust and control and psychological management. Techniques that fell into enhancing trust and control included the categories of 'building a trustful relationship', 'informational control', and 'behavioral control'. These techniques were used consistently throughout the sessions. Additionally, psychological management techniques were identified and classified as 'behavioral strategies: relaxing the body' and 'cognitive strategies: relaxing the mind', which were regularly used in specific situations.

CONCLUSION

The results indicate that a variety of dental anxiety management techniques were used during one-session treatments. The findings provide valuable insights for dentists in managing their patients with dental anxiety and improving their overall treatment experience.

Associations between pain-related temporomandibular disorders and dental anxiety at 46 years of age in the Northern Finland Birth Cohort 1966

OBJECTIVES

The aims were (1) to study the association between dental anxiety (DA) and temporomandibular disorders (TMDs) and whether subgroups formed differ in psychological symptoms and pain sensitivity in the Northern Finland Birth Cohort 1966 and (2) to confirm the factor structure of the Hopkins Symptom Checklist-25 assessing psychological symptoms.

MATERIALS AND METHODS

Data were acquired using questionnaires and clinical examinations at age 46 years (n = 1889). Dental anxiety was assessed with Modified Dental Anxiety Scale (MDAS). Pain-related TMD (myalgia, arthralgia) were assessed according to modified diagnostic criteria for temporomandibular disorders. Pressure pain threshold and tolerance were measured with an algometer. Explanatory factor analysis revealed three factors, named 'depression', 'anxiety' and 'distress'.

RESULTS

Those with high DA and myalgia and/or arthralgia reported higher depression (mean = 1.52), anxiety (mean = 1.61) and distress (mean = 2.06) scores, and lower pressure pain threshold (mean = 496 kPa) and tolerance (mean = 741 kPa) values than those with only DA (1.22; 1.56; 1.84; 613; 875), TMD (1.21; 1.39; 1.83; 600; 908) or neither (1.12; 1.29; 1.58; 707; 1006), respectively.

CONCLUSIONS

Patients with DA and/or myalgia/arthralgia have similar profiles regarding pain sensitivity and psychological symptoms, the burden being highest among those with DA and a TMD diagnosis.

Oral health-related quality of life among home-dwelling older people with and without domiciliary care

OBJECTIVES

The aim was to compare oral health-related quality of life (OHRQoL) between home-dwelling older people with and without domiciliary care when adjusted for gender, education, use of dental services and removable dental prostheses.

BACKGROUND

OHRQoL of home-dwelling older people with and without domiciliary care is a neglected area of research, with few studies having been conducted.

MATERIALS AND METHODS

A secondary analysis was conducted on the Finnish Health 2011 interview data. Home-dwelling participants (age ≥ 70) with or without domiciliary care were included (n = 758). OHRQoL was measured with the Oral Health Impact Profile questionnaire (OHIP-14) calculating three outcomes: prevalence of at least one impact reported: "occasionally," "fairly often" or "very often" (OFoVo), severity as mean sum score and mean of the seven OHIP-14 dimensions. These were evaluated by use of domiciliary care using logistic and negative binomial regression analyses.

RESULTS

Domiciliary care clients tended to have poorer OHRQoL than non-clients (severity mean 4.33 vs 4.11, P = .057), especially men (6.71 vs 4.15, P = .027), and reported more psychological discomfort than non-clients (mean 1.10 vs 0.82, P = .039). The use of removable dental prostheses was the strongest predictor (OR 2.84, P < .001) of poor OHRQoL.

CONCLUSION

Domiciliary care clients tended to report poorer OHRQoL, especially with regard to psychological discomfort dimension than non-clients. Thus, support of oral hygiene and regular utilisation of oral health services should be part of domiciliary care among older people to enhance OHRQoL.

Dental service voucher for adults: patient experiences in Finland

OBJECTIVE

To investigate how patients experienced a new dental service voucher, what influenced the patient experience, and the use of such vouchers.

MATERIALS AND METHODS

An SMS-linked patient survey was sent to all patients (n = 1,000) that had received the voucher. The survey consisted of 23 questions (20 multiple choice, 3 open-ended), included themes like access to treatment, use of the voucher, and patient experience. Statistical analyses included Chi-square, Fisher's exact, Mann-Whitney U tests, and Spearman's rank correlation.

RESULTS

The response rate was 25.7%. Patient experience was on average very good. Of the respondents, 148 (57.6%) reported that the voucher was very simple to use, 160 (62.3%) considered that they were helped very well, and 149 (58%) would have very willingly used a voucher again. Those who used the voucher reported an overall better patient experience, as did those with good oral health. Of those reporting unused service vouchers, 14 (67%) preferred to use the public oral health care services instead.

CONCLUSIONS

Notwithstanding a relatively low response rate, the results can be utilized to identify patients who need more support in using the voucher, and therefore to target information and guidance more effectively.

Gender differences in the association between malocclusion traits and oral health-related quality of life in Finnish adults

We aimed to evaluate the gender-specific associations of malocclusion traits with oral health-related quality of life (OHRQoL) among Finnish adults. Data were obtained from the Health 2000 Survey, Finland. Included participants (n = 3993) were ≥30 years old with OHRQoL and occlusion data. OHRQoL was measured using the 14-item Oral Health Impact Profile (OHIP-14). OHIP-14 severity mean score, prevalence of impacts, and means of seven dimensions were outcomes. Explanatory variables were any malocclusion trait, increased overjet, negative overjet, open bite, deep bite, and crossbite/scissor bite. Logistic (prevalence) and cumulative (severity) regression models were adjusted for age, decayed teeth, deep periodontal pocket, occluding pairs, orthodontic treatment, and self-perceived health. Gender modified the association between any malocclusion trait and OHRQoL, with the association being stronger in females. Females without any malocclusion trait (OR = 1.62, 95% CI = 1.14-2.28) or without crossbite/scissor bite (OR = 1.68, 95% CI = 1.16-2.43) had better OHRQoL (lower prevalence) than those with malocclusions. Males without increased overjet (OR 1.50, 95% CI = 1.04-2.17) had lower mean OHIP-14 severity score than males with increased overjet, after adjustments. The association between psychological and physical disability and malocclusion traits was different between males and females. Gender differences in the impact of malocclusion traits should be considered when assessing orthodontic treatment need.

Parent's self-reported tooth brushing and use of fluoridated toothpaste: Associations with their one-year-old child's preventive oral health behaviour

OBJECTIVE

The aim of the study was to examine if the tooth brushing frequency and use of fluoridated toothpaste of the mother and father were associated with the tooth brushing frequency and use of fluoridated toothpaste for their 1-year-old child.

METHODS

This cross-sectional study is part of the FinnBrain Birth Cohort Study. Questionnaire data were obtained from 1672 mothers and 867 fathers on tooth brushing and use of fluoridated toothpaste, age, education, number of siblings and parity (when the child was 1-year-old). For 763 families (mother and father), data from both parents were available. Tooth brushing was dichotomized to at least twice daily (2× day) and less than 2× day, and use of fluoridated toothpaste for child to at least once daily and less than once daily. The association between brushing of child's teeth (both parents less than 2× day) and use of fluoridated toothpaste for the child (both parents less than once daily) with parent's own tooth brushing was modelled with logistic regression analyses adjusted for family-related variables (parents' age and education, number of older siblings) using odds ratios (OR) and 95% confidence intervals (CI).

RESULTS

Families in which both parents brushed their own teeth less than 2× day were more likely to brush their child's teeth less than 2× day than families in which both parents brushed their own teeth 2× day (OR = 9.23; 95%CI = 5.42-15.69). The likelihood of not brushing the child's teeth 2× day was less strong when at least one of the parents brushed his/her own teeth 2× day (mother 2× day: OR = 1.97; 95%CI = 1.25-3.10; father 2× day: OR = 2.85; 95%CI = 1.51-5.40).

CONCLUSIONS

Less frequent tooth brushing of both mothers and fathers was strongly associated with less frequent tooth brushing of their child. When educating parents on child oral home care, parents' own home care and inclusion of fathers also need more attention.

Concurrent changes in dental anxiety and smoking in parents of the FinnBrain Birth Cohort Study

We evaluated associations between changes in dental anxiety and tobacco use, adjusted for general anxiety and depressive symptoms. The FinnBrain Birth Cohort Study data, collected at gestational weeks 14 and 34 and at 3 months postpartum, were used. Questionnaires included the Modified Dental Anxiety Scale (MDAS), the Edinburgh Postnatal Depression Scale (EPDS), and the anxiety subscale of the Symptom Checklist-90 (SCL). Smoking was categorized as "stable non-smoking", "started smoking", "quit smoking", and "stable smoking". Changes in smoking and dental anxiety were evaluated "during pregnancy" (i.e., from gestational week 14 to gestational week 34) in 2442 women and 1346 men and "after pregnancy" (i.e., from gestational week 34 to 3 months postpartum) in 2008 women and 1095 men. Changes were evaluated in three smoking categories (stable non-smoking, fluctuating, and stable smoking), using data from all three time-points (1979 women and 1049 men). Modeling used repeated measures analysis of covariance. Stable smoking mothers had statistically significantly higher levels of dental anxiety (mean MDAS 12.3-12.6) than non-smoking mothers (mean MDAS 10.1-10.7) or mothers who smoked at some point during pregnancy (mean MDAS 10.8-11.5). A similar tendency was observed in fathers. However, no systematic change in dental anxiety by changes in smoking habits was observed. Those smoking during pregnancy and with high dental anxiety may need special support for smoking cessation.

Association of service use with subjective oral health indicators in a freedom of choice pilot

OBJECTIVES

A freedom of choice pilot provided access to private oral health care services without queuing and with fixed public service-fees for participants in Tampere region, Finland in 2018-2019. The aim of this study was to investigate how use of oral health care services differed by demographics, socioeconomic status, dental fear, and self-reported oral health in this pilot.

MATERIAL AND METHODS

SMS-messages including a link to online questionnaire were sent to participants who had booked an appointment, and to those who had not booked an appointment despite registering to pilot. We categorized participants to (1) those who had booked their first appointment before receiving SMS (visitors), (2) those who booked an appointment after receiving the SMS-message (late-visitors), and (3) those who had not booked an appointment during pilot (nonvisitors). We used regression analysis to estimate the association of age, gender, dental fear, economic situation, Oral Health Impact Profile-14-severity (oral health-related quality of life [OHRQoL]), self-reported oral health and need for oral health care (exposures) with oral health care service use during the pilot (outcome).

RESULTS

Out of 2300 participants, 636 (28%) responded. Late-visitors were more likely older and reported more likely need for oral health care, poorer oral health and OHRQoL than visitors or nonvisitors. Nonvisitors were younger and had better OHRQoL than the others. The differences in the service use by gender, economic situation, and dental fear were small.

CONCLUSIONS

Service use during the pilot depended on the subjective oral health. Our findings highlight the potential of reminders in increasing care use among those with perceived need for services.

Associations between temperament dimensions and dental anxiety in parents of the FinnBrain Birth Cohort Study

We evaluated associations between dental anxiety and four temperament dimensions: effortful control, extraversion/surgency, negative affect and orienting sensitivity among 2558 parents in the FinnBrain Birth Cohort Study. Dental anxiety was measured with the Modified Dental Anxiety Scale, and temperament with the Adult Temperament Questionnaire. Associations between dental anxiety and temperament dimensions were modelled using linear and logistic (cut-off ≥ 19 for high dental anxiety) regression analyses adjusting for general anxiety and depressive symptoms, age and education. In women and men, dental anxiety was positively associated with negative affect (women β = 1.10; 95%CI 1.06-1.15; men β = 1.11; 95%CI 1.05-1.18) and negatively associated with effortful control (women β = 0.95; 95% CI0.92-0.99, men β = 0.90; 95% CI 0.85-0.95). In women, extraversion/surgency was also positively associated with dental anxiety (β = 1.04; 95%CI 1.00-1.08). For high dental anxiety, negative affect in women (OR = 2.00; 95%CI 1.31-3.06) and men (OR = 5.21; 95%CI 1.72-15.83) and for extraversion/surgency in women (OR = 1.50; 95%CI 1.01-1.47) associated positively with dental anxiety, but for effortful control, the association was not statistically significant. Dentists should understand that temperament dimensions affect the risk for dental anxiety more strongly than general anxiety or depressive symptoms. Dimensions negative affect and extraversion/surgency may increase and effortful control decrease the risk.

Gender-specific associations between the dimensions of alexithymia personality trait and dental anxiety in parents of the FinnBrain Birth Cohort Study

We evaluated gender-specific associations of two dimensions of dental anxiety (anticipatory and treatment-related dental anxiety) with three dimensions of alexithymia: difficulty in identifying feelings, difficulty in describing feelings, and externally oriented thinking. The sample comprised 2558 parents from the general population participating in the FinnBrain Birth Cohort Study. Dental anxiety was measured with the Modified Dental Anxiety Scale and alexithymia with the 20-item Toronto Alexithymia Scale. Associations between dental anxiety and alexithymia dimensions were modelled using linear regression analysis adjusting for general anxiety and depressive symptoms, age, and education. Structural equation modeling assessed their interrelationships. In women, anticipatory dental anxiety was associated only with difficulty in identifying feelings, but treatment-related dental anxiety was associated with difficulty in identifying feelings, difficulty in describing feelings, and externally oriented thinking. In men, anticipatory dental anxiety was associated with only externally oriented thinking, whereas treatment-related dental anxiety was associated with difficulty in describing feelings, and with externally oriented thinking. Structural equation modelling showed that difficulty in identifying feelings was associated with anticipatory and treatment-related dental anxiety in women, whereas in men, only difficulty in describing feelings was associated with both types of dental anxiety. Anticipatory and treatment-related dental anxiety have different associations with alexithymia dimensions.

Modification of national OSCE due to COVID-19 - Implementation and students' feedback

AIM

The aims were to describe the development of a modified national online OSCE during COVID-19 and assess related student feedback.

MATERIAL AND METHODS

The modified online OSCE comprising of eight question entities was organised simultaneously in all four dental institutes of Finland using the Moodle virtual learning environment. All fourth-year students (n = 179) attended the examination online at home. Student feedback was collected via an anonymous questionnaire with multiple-choice questions and open-ended questions concerning attitudes towards the modified online OSCE, as well as content and usability of the question entities in the examination. Means and standard deviations were calculated for multiple-choice questions. Content analysis was used for open-ended questions.

RESULTS

Of 179 students, 119 (66%) consented to the study. Students experienced they had received adequate information (mean 3.8; SD 1.2), had a positive attitude before the examination (4.0; 1.0) and found the practice test useful (3.7; 1.1) (range 1-5). Technical implementation (2.7; 0.7) and the difficulty of the questions (2.9; 0.6) (range 1-4) were found to be good. The teaching students received during their studies was sufficient (3.2; 0.5) (range 1-4). Content (mean 3.2; 0.4) and usability (2.9; 0.4) of the question entities were good (range 1-4). The themes arising from open-ended questions were importance and practicality of the topic (in questions) in relation to the work of a dentist and gratitude for the rapid conversion of the OSCE into an online examination despite COVID-19. The themes arising from negative experiences included difficulties in completing the examination within the time allocated, and dissatisfaction with the model answers provided after the examination.

CONCLUSION

The positive student feedback towards the modified online OSCE encourages including an online examination to complement the traditional OSCE.

Is the oral health-related quality of life associated with quality of life among pregnant Finnish families: a cross-sectional study

OBJECTIVE

The objectives of this study was to find out if oral health-related quality of life and its dimensions (OHRQoL) are associated with overall quality of life (QoL) among mothers and fathers during pregnancy and whether these two constructs were associated within the family sharing the same living environment.

MATERIAL AND METHODS

The data (mothers n = 2580, fathers n = 1467) for this cross-sectional data study were collected from the FinnBrain Birth Cohort study during 2011-2015. OHRQoL was measured using a 14-item Oral Health Impact Profile (OHIP-14) questionnaire and QoL by using the WHOQoL-Bref questionnaire. Spearman correlation coefficients were used to assess the statistical significance of the associations.

RESULTS

OHRQoL was weakly associated at the individual level with the overall QoL (mothers r = 0.21, fathers r = 0.22, p < 0.001), but the correlations within families were low for QoL and OHRQoL.

CONCLUSIONS

Our findings suggest that overall QoL is a different construct than OHRQoL though slightly overlapping.

Concurrent heavy use of general and oral health services among Finnish adults

OBJECTIVE

The aim was to identify heavy users of public health (PHS) and public oral health (POHS) services and combined and concurrent users of these services.

MATERIAL AND METHODS

Numbers of 18+ year-old patients and their visits to POHS (12,124 patients) and PHS (28,479 patients) were collected from two patient registers in a Finnish town in 2013. The combined dataset consists of 32,481 patients. Using a highest decile criterion for both for POHS and PHS, those patients who had made 8 or more visits were categorised as heavy users. Patients who had made total of 10 or more visits to the POHS and/or PHS were categorised as combined heavy users. Patients who had made 8 or more visits to both the POHS and PHS were categorised as concurrent heavy users (195 patients).

RESULTS

Heavy users of POHS were more often men and those of PHS more often women. Combined heavy users were likely to be women and to be older. The combined heavy users accounted for 40% of all visits of POHS and/or PHS. Among them 30% did not have any POHS visits and 4% did not have any PHS visits. Concurrent heavy use was rare, involving 0.06% of all patients, but made 3.4% of all visits.

CONCLUSIONS

Of the patients making 10 or more POHS and/or PHS visits, only five percent were concurrent heavy users of both services. As many non-communicable diseases share common risk factors the combined heavy users of PHS should be directed to use POHS and vice versa.

Perceived oral health and oral health behaviours among home-dwelling older people with and without domiciliary care

OBJECTIVES

The aim was to compare the perceived oral health and oral health behaviours of home-dwelling older people with and without domiciliary care.

BACKGROUND

Oral health is poor in long-term care, but less is known about perceived oral health of home-dwelling older people receiving domiciliary care.

MATERIALS AND METHODS

Data from the Health 2000 and Health 2011 surveys (BRIF8901) were used. Interview participants were at least 70 years old and living at home with or without domiciliary care (n = 1298 in 2000 and n = 1027 in 2011). Differences in perceived oral health (subjective oral health, pain, eating difficulties) and oral health behaviours (hygiene, use of services) were compared based on the use of domiciliary care and stratified by gender. Differences between groups were compared with the chi-square test.

RESULTS

In 2011, compared to non-clients, domiciliary care clients more often had poor subjective oral health (40.3% vs. 28.9%, P = .045). In both surveys, they also used oral health services less recently (2000, 76.4% vs. 60.9%; and 2011, 61.1% vs. 46.6%) and more often had difficulties chewing hard food (2000, 50.6% vs. 34%, P < .001; and 2011, 38.4% vs. 20.7%, P < .001) than non-clients. In 2000, clients had more difficulty eating dry food without drinking (39.5% vs. 21.6%, P < .001) and cleaning their teeth and mouth (14.3% vs. 1.1%, P < .001) than non-clients. Women clients in 2011 brushed their teeth less often than non-clients (43.5% vs. 23.7%, respectively, P = .001).

CONCLUSION

Domiciliary care clients have poorer perceived oral health, and greater difficulties with eating and oral hygiene maintenance than non-clients.

Changes and determinants of unmet oral health treatment need

OBJECTIVES

Our aim was to describe the nature and determinants of the changes in unmet treatment need between the years 2000 and 2011 after a major oral healthcare reform and a wider supply of subsidized care.

METHODS

The study used a longitudinal sample (n = 3838) of adults who had participated in both the Health 2000 and 2011 surveys (BRIF 8901). Those reporting self-assessed treatment need without having visited a dentist in the previous 12 months were categorized as having unmet treatment need. Two logistic regression models were applied to determine the effects of predisposing and enabling factors on change in unmet treatment need. Model 1 was conducted among those who reported unmet treatment need in 2000 and evaluated the determinants for improvement. Model 2 was conducted among those who did not have unmet treatment need in 2000 to evaluate the risk factors for having unmet treatment need by 2011.

RESULTS

Unmet treatment need was reported by 25% of the participants in 2000 and by 20% in 2011. Those with unmet treatment need in 2000 were less likely to report improvement by 2011 if they had poor subjective oral health, basic or intermediate education level, or poor perceived economic situation in 2000. Those who did not have unmet treatment need in 2000 were more likely to have it in 2011 if they were males or from northern Finland and less likely to if they came from central Finland or were older.

CONCLUSIONS

The wider supply of subsidized oral health care during the study years did not lead to complete elimination of treatment need. The determinants of unmet treatment need, such as low or intermediate education level and perceived economic difficulties, should be used in targeting the services at those with treatment need to achieve better oral health outcomes.

Psychometric Properties of the Japanese Version of the Single Dental Anxiety Question: A Cross-sectional Online Survey

Background:

Assessment of dental anxiety using a validated questionnaire is important for its management and survey.

Objective:

The aim of this cross-sectional online survey was to evaluate the psychometric properties of the Japanese version of the Single Dental Anxiety Question (SDAQ).

Methods:

The single question was translated into Japanese following the forward-backward method. Four hundred Japanese internet monitors (age 20–79 years) were included in the study. Sensitivity–specificity analysis and the Kappa coefficient were calculated against the Modified Dental Anxiety Scale (MDAS) using the 19 cutoff score for high dental anxiety. Criterion validity was evaluated using age, gender, dental attendance pattern, negative dental experiences, and subjective oral health.

Results:

Among these subjects, 11% were found to have high dental anxiety on the MDAS score and 9% rated themselves as very afraid of SDAQ. The Kappa coefficient between the MDAS cutoff score and the SDAQ classification was 0.58, the sensitivity was 0.56, and the specificity was 0.97. The SDAQ was associated with gender (P = 0.018), dental attendance pattern (P = 0.020), negative dental experiences (P < 0.001), and subjective oral health (P < 0.001).

Conclusion:

The Japanese version of the SDAQ has good criterion and construct validity but lower sensitivity than the original version. It can be used to assess dental anxiety in large dental surveys or clinical settings where a multi-item questionnaire is not feasible.

Changes in dental fear and its relations to anxiety and depression in the FinnBrain Birth Cohort Study

This study aimed to: (i) evaluate short-term changes in dental fear during a 9-month period among women and men, and (ii) evaluate whether the course and magnitude of changes in dental fear were associated with changes in depression and anxiety. The longitudinal data of the FinnBrain Birth Cohort Study were used. Out of 3808 women and 2623 men, 1984 women and 1082 men filled in the Modified Dental Anxiety Scale (MDAS) at gestational weeks 14 and 34, and 3 months after childbirth. Other questionnaires used were the Edinburgh Postnatal Depression Scale and the anxiety subscale of the Symptom Checklist-90. All scales were analyzed as sum scores. The MDAS was also trichotomized to assess the stability of dental fear. Statistical significances of the changes in dental fear, depression, and general anxiety were evaluated using repeated-measures Friedman tests. Correlation coefficients were used to describe the associations between measures (Spearman) and their changes (Pearson). Dental fear more often increased than decreased, but for the majority it was stable. On average, dental fear, depression, and anxiety symptoms correlated throughout the study. The correlations tended to be stronger with depressive symptoms. However, the relationships between changes in dental fear, depression, and anxiety were not systematic.

Tobacco use and dental fear among 15-16 year-old adolescents in Finland

OBJECTIVE

The aim of this cross-sectional study was to evaluate the association between tobacco use and dental fear when adjusting for gender, parent's level of education and oral health habits.

MATERIAL AND METHODS

This secondary analysis used questionnaire data from 15- and 16-year-old adolescents and their parents (n=2486). Ninety-four percent of the adolescents and 73% of the parents responded. For logistic regression analysis, variables were categorized as follows: dental fear (dependent) 0=not at all to somewhat afraid, 1=quite or very afraid; tobacco use (independent) 0=never, 1=occasionally or more often; and for confounders: tooth-brushing 0=at least twice a day, 1=once a day or less often; xylitol products 0=at least three times a day, 1=two times a day or less often; and parents' occupation: 0=both low, 1=high+low, and 2=both high.

RESULTS

2223 adolescents were included in the final analyses resulting in a 89% response rate. Those using tobacco at least occasionally were more likely to have dental fear than those who reported they had never used tobacco, also when adjusting for oral health habits, gender and parents' occupation (OR=1.74, 95% CI=1.31-2.33).

CONCLUSIONS

Adolescent tobacco users were more likely to have dental fear than non-users. Dental teams should consider this when meeting adolescents who have dental fear and/or are using tobacco. The possible common vulnerability factors for dental fear and tobacco use needs further study.

Virtual Reality Relaxation to Decrease Dental Anxiety: Immediate Effect Randomized Clinical Trial

Introduction:

Dental anxiety is common and causes symptomatic use of oral health services.

Objectives:

The aim was to study if a short-term virtual reality intervention reduced preoperative dental anxiety.

Methods:

A randomized controlled single-center trial was conducted with 2 parallel arms in a public oral health care unit: virtual reality relaxation (VRR) and treatment as usual (TAU). The VRR group received a 1- to 3.5-min 360° immersion video of a peaceful virtual landscape with audio features and sound supporting the experience. TAU groups remained seated for 3 min. Of the powered sample of 280 participants, 255 consented and had complete data. Total and secondary sex-specific mixed effects linear regression models were completed for posttest dental anxiety (Modified Dental Anxiety Scale [MDAS] total score) and its 2 factors (anticipatory and treatment-related dental anxiety) adjusted for baseline (pretest) MDAS total and factor scores and age, taking into account the effect of blocking.

Results:

Total and anticipatory dental anxiety decreased more in the VRR group than the TAU group (β = −0.75, P < .001, for MDAS total score; β = −0.43, P < .001, for anticipatory anxiety score) in patients of a primary dental care clinic. In women, dental anxiety decreased more in VRR than TAU for total MDAS score (β = −1.08, P < .001) and treatment-related dental anxiety (β = −0.597, P = .011). Anticipatory dental anxiety decreased more in VRR than TAU in both men (β = −0.217, P < .026) and women (β = −0.498, P < .001).

Conclusion:

Short application of VRR is both feasible and effective to reduce preoperative dental anxiety in public dental care settings (ClinicalTrials.gov NCT03993080).

Knowledge Transfer Statement:

Dental anxiety, which is a common problem, can be reduced with short application of virtual reality relaxation applied preoperatively in the waiting room. Findings of this study indicate that it is a feasible and effective procedure to help patients with dental anxiety in normal public dental care settings.

Dental students' and patients' perceived importance and knowledge of dental anxiety

AIM

To examine the perceived importance and knowledge of the dental students' in their treatment of dental anxiety according to their year of study and to find out patients' perceived importance of the dental students' knowledge of dental anxiety according to their level on dental fear.

METHODS

Dental students (N = 219) at the University of Turku and non-probability convenience sample of 100 of patients attending the Dental Teaching Clinic were given questionnaires with multiple choice and open-ended questions. Students were categorised into three groups according to the year of study (1-3, 4, 5). Patients were categorised into three groups using the established cut points for Modified Dental Anxiety Scale (no fear = 5-9, low fear = 10-18, high fear = 19-25). The differences between groups were evaluated using cross-tabulations, chi squared and Fisher's exact tests. The open-ended questions were subjected to content analysis.

RESULTS

Students' perceived importance of dental anxiety did not differ between three groups. Students with greater undergraduate education and clinical experience were more likely to have excellent or quite good knowledge (P < .001). Patients' perceived importance of dental students' knowledge of dental anxiety was greater in patients with high level of fear. The overlapping category that emerged from the open-ended question analysis was communication skills. This appeared to be important for patients with dental anxiety and for dental students in their management of dental anxiety.

CONCLUSION

Clinical communication skills should be part of dental anxiety management teaching. Dental students should be able to gain sufficient knowledge and skills in treating dental anxiety before graduating.

Costs of dental care and its financial impacts on patients in a population with low availability of services

OBJECTIVES

To determine the direct and indirect costs of accessing and utilizing dental services in Tanzania and the proportion of patients experiencing economic burden due to treatment costs.

BASIC RESEARCH DESIGN

Survey of 489 dental patients utilizing an out-of-pocket payment modality was carried out in four regional hospitals. Direct and indirect costs for service utilization were calculated. Financial expenditures were used to assess significant financial impacts of utilization of dental services on household economies.

RESULTS

Direct costs comprised 80% of the total treatment costs, whereas indirect costs comprised 20%. About half of the patients experienced significant financial impacts as a result of their utilization of dental services. Proportionately more patients from low-income households (92.2%) experienced significant financial impacts. Most patients attended the clinics due to toothache and the most widely expected treatment was dental extraction. Only 7.1% of the patients received a filling. The costs for dental restorations were three-times those for tooth extraction.

CONCLUSIONS

Dental service utilization leads to significant financial impacts on many of the households in this setting. Increasing the rate of prepayment for health services and reducing income inequality may help to mitigate these impacts.

School-level changes in factors related to oral health inequalities after national recommendation on sweet selling

Aims: In 2007, Finnish authorities gave a national recommendation that schools should not sell sweet products. This study aimed to determine the effects of the national recommendation on school-level intermediary determinants (factors related to oral health inequalities) and if the changes were different according to school-level socio-economic position (SEP). Methods: This ecological and longitudinal study combined school-level data from two independent studies from Finnish upper comprehensive schools (N = 970): the School Health Promotion study (SHPS) and the School Sweet Selling survey (SSSS). The baseline data (SHPS from 2006-2007 and SSSS from 2007) and the post-intervention data (SHPS and SSSS from 2008-2009) were combined into a longitudinal school-level data set (n = 360 and response rate = 37%). The intermediary determinants were: attitudes and access to intoxicants, school health services, school environment, home environment, schools' health-promoting actions (including sweet product selling) and pupils' eating habits. Three equal-sized school-level SEP group - slow, middle and high - were formed. The changes in the intermediary determinants were analysed using Wilcoxon Signed Ranks test. Differences between school SEP groups were analysed the using Kruskal-Wallis test. Longitudinal linear mixed modelling was used to determine the contribution of intermediary determinants to the changes in pupils' eating habits. Results: The national recommendation was effective in decreasing sweet product selling at schools and the effect was equal in each school-level SEP group. Intermediary determinants contributed differently to eating habits in the three SEP groups. Conclusions: A national recommendation seems to be an effective tool in making the school environment healthier without increasing inequalities.

Adult Finns' perceptions about communication with the dentist during their latest visit

OBJECTIVES

The aim of this study was to investigate adult Finns' perceptions about communication with the dentist during their latest visit in three aspects: receiving adequate information about health status and care, being listened to and shown interest by the dentist, and being able to influence the treatment decisions.

METHODS

Data were taken from the Health 2011 Survey (BRIH8901). A representative sample (n = 5806) of adult Finns aged over 29 years old was interviewed or alternatively filled in a questionnaire. Basic descriptive tabulations, Rao-Scott chi-square tests and logistic regression analyses were used to study how socioeconomic status, perceived oral health and oral Health care variables are associated with the three aspects of communication with the dentist.

RESULTS

Most (85%-90%) adult Finns felt that, during their latest visit to a dentist, they had received adequate information, were listened to and shown interest by their dentist, and that they had been able to influence the treatment decisions. Those who perceived poor oral health, felt visiting dentist somewhat frightening, were in a difficult economic situation, visited a public dentist, or tended to visit oral Health care services irregularly, felt more often that there was a deficit in communication with the dentist.

CONCLUSIONS

In 2011, most adult Finns did not report any deficit in communication with the dentist during their latest visit. Oral Health care professionals should focus more on communicating with patients who have economic problems, poor oral health, dental fear or a problem-oriented visiting pattern.

Dental and periodontal health in Finnish adults in 2000 and 2011

OBJECTIVE

We assessed dental and periodontal health in adults aged ≥30 years living in southern and northern Finland as part of the Health 2000/2011 Surveys (BRIF8901).

MATERIAL AND METHODS

Clinical findings in 2000 (n = 2967) and 2011 (n = 1496) included the presence of teeth and number of teeth with caries, fillings, fractures or periodontal pockets.

RESULTS

Edentulousness decreased in all age groups. The prevalence of those with no caries increased from 67% to 69% in men and from 80% to 85% in women, and of those with no periodontal pocketing from 26% to 30% in men and from 39% to 42% in women. In 2011, the mean number of decayed teeth was 0.8 in men and 0.3 in women, and the corresponding mean numbers of teeth with deepened periodontal pockets 5.6 and 3.7. The gender difference had levelled concerning edentulousness, number of teeth and DMF teeth, but still existed in the occurrence of caries and periodontal pocketing.

CONCLUSION

The findings were in line with other population-based reports in the 2000s. However, periodontal health in Finland seems not to be as good as in many European countries and in the USA.

Social gradient in intermediary determinants of oral health at school level in Finland

OBJECTIVE

An adapted framework for oral health inequalities suggests that structural determinants cause oral health inequalities through socio-economic position (SEP) and intermediary determinants. We applied this framework to examine whether there is a social gradient in the intermediary determinants at the school level, even when adjusted for school size, geographical location and teaching language.

BASIC RESEARCH DESIGN

Cross-sectional survey.

METHODS

This study combined data from two independent studies focusing on Finnish upper comprehensive schools (N=970): the School Health Promotion study (SHPS) and the School Sweet Selling survey (SSSS). All schools that took part in the SSSS and whose pupils answered the SHPS were included in the analysis (n=360, response rate=37%). From the questions of the SHPS and the SSSS suitable for the theoretical framework, attitudes and access to intoxicants, school health services, school environment, home environment, the school's oral health-related actions and the pupil's own behaviour were selected as the intermediary determinants and as the factors determining the school-level SEP. The social gradient in the intermediary determinants of oral health was investigated with Pearson's and Spearman's correlation coefficients between those and the school-level SEP. In the multivariable analysis, the General Linear Model with manual backward elimination was used.

RESULTS

A social gradient was observed in the intermediary determinants 'home environment' and 'the pupils' tooth brushing frequency' and an inverse social gradient in 'attitudes and access to intoxicants' and 'school health services'.

CONCLUSIONS

Social gradient between schools could increase Finnish adolescents' oral health inequalities.

Knowledge, perceived skills and activities of nursing staff to support oral home care among older domiciliary care clients

BACKGROUND

Increasing number of older adults lives in their own homes, but needs help in many daily routines. Domiciliary care nursing staff (DCNS) is often needed to support oral home care. However, information of nursing staff's knowledge, skills and activity in this task is sparse.

OBJECTIVES

The study aimed to assess DCNS knowledge, perceived skills and activities to support oral home care of older domiciliary care clients.

MATERIAL AND METHODS

The study was conducted among DCNS in one of the largest cities in Finland. All DCNS members (n = 465) received a questionnaire with 14 multiple choice and open questions regarding the perceived skills, knowledge and activities of oral health guidance of older domiciliary care clients. In total, 115 (25%) DCNS members returned the questionnaires. Frequencies, percentages, means and standard deviations were used to describe the samples and study variables. DCNS was categorised according to age and working years for group comparisons, which were assessed with chi-squared test.

RESULTS

Knowledge concerning oral health was mostly on a high level. Around 50% of DCNS considered their knowledge regarding dental prosthesis hygiene as sufficient. Of the DCNS, 67% informed that they had received education on oral health care. However, over 50% of the DCNS had a need for further education in issues related to oral home care. DCNS were active in supporting most oral and prosthesis hygiene means, yet less in guidance concerning toothbrushing. Activity to support cleaning the interdental spaces was the weakest, in which only 12% of the respondents considered having average or excellent skills. Younger DCNS had better knowledge on oral home care due to recent education, but older staff members were more skilful in performing oral hygiene measures.

CONCLUSIONS

There is a need for structured instructions and training on oral home care for DCNS. Oral home care should be taken into account more often and regularly.

A longitudinal study of changes and associations in dental fear in parent/adolescent dyads

BACKGROUND

Dental fear seems to fluctuate, but concordance of changes in dental fears between parent/adolescent dyads has not been reported.

AIM

To study longitudinally the associations between adolescent and parental dental fears and their changes.

DESIGN

Adolescents and parents reported their dental fear independently of each other when adolescents were between 11-12 and 15-16-year-olds. Eight hundred and seventeen eligible parent/adolescent dyads were included in the analyses. Dental fear was measured with a single question using five response alternatives. Associations between adolescent and parental dental fears and their changes were analysed using χ² tests and correlation coefficients.

RESULTS

Prevalence of dental fear remained rather similar during the study. There was a positive association between adolescent and parental dental fears in early adolescence (P < 0.001) but at middle adolescence only among parent/girl dyads (P = 0.007 for girls, P = 0.341 for boys). Changes in dental fear among parent/adolescent dyads did not correlate statistically significantly. Difference between girls' and boys' change in dental fear was statistically significant (P = 0.001). Dental fear increased more often among girls than among boys. Boys had stable low/no dental fear more often than girls did.

CONCLUSION

Adolescents' and parents' dental fears seemingly change independently of each other.

Translation and validation of the Finnish version of index of dental anxiety and fear (IDAF-4C+) among dental students

BACKGROUND

Dental fear accounts for 41% of the non-habitual dental attendance such as visiting only when in pain among adult Finns. Dentists should be able to recognize patients in risk for irregular attendance due to dental fear and measure their fear with valid and reliable instrument that capture the multidimensionality of dental fear. The study's aim was to translate the Index of Dental Anxiety and Fear (IDAF-4C+) into Finnish and test its reliability and validity.

METHODS

The study population consisted of dental students in a Finnish university (n = 202). The IDAF-4C⁺ was back-and forward translated by experts as well as a native English translator, blinded to the original version. Reliability was assessed using Cronbach's alpha. Validity of the IDAF-4C⁺ was assessed against the Modified Dental Anxiety Scale (MDAS) using Spearman correlation coefficients and through the use of Exploratory factor analysis (EFA) and between genders using Mann-Whitney U tests.

RESULTS

The reliability of the IDAF-4C⁺ was good, the Cronbach's alpha being 0.88. The IDAF-4C⁺ and MDAS and their subscales were correlated, with coefficients varying between 0.34 and 0.85. Correlations were stronger with the emotional and physiological components of the IDAF-4C⁺. EFA revealed one factor explaining 51.7% of the common variance (eigenvalue = 4.6). Women tended to have slightly higher mean scores than men (1.49 vs. 1.36, p = 0.247).

CONCLUSIONS

The translation and localization of the Finnish version of the IDAF-4C⁺ can be considered as providing some evidence of the validity and reliability of the scale. It adds to previously used measures as it considers also the behavioral, cognitive and physiological dimension involved in dental fear.

Use of oral health care services in Finnish adults - results from the cross-sectional Health 2000 and 2011 Surveys

Background

During the 2000s, two major legislative reforms concerning oral health care have been implemented in Finland. One entitled the whole population to subsidized care and the other regulated the timeframes of access to care. Our aim was, in a cross-sectional setting, to assess changes in and determinants of use of oral health care services before the first reform in 2000 and after both reforms in 2011.

Methods

The data were part of the nationally representative Health 2000 and 2011 Surveys of adults aged ≥ 30 years and were gathered by interviews and questionnaires. The outcome was the use of oral health care services during the previous year. Determinants of use among the dentate were grouped according to Andersen’s model: predisposing (sex, age group), enabling (education, recall, dental fear, habitual use of services, household income, barriers of access to care), and need (perceived need, self-rated oral health, denture status). Chi square tests and logistic regression analyses were used for statistical evaluation.

Results

No major changes or only a minor increase in overall use of oral health care services was seen between the study years. An exception were those belonging to oldest age group who clearly increased their use of services. Also, a significant increase in visiting a public sector dentist was observed, particularly in the age groups that became entitled to subsidized care in 2000. In the private sector, use of services decreased in younger age groups. Determinants for visiting a dentist, regardless of the service sector, remained relatively stable. Being a regular dental visitor was the most significant determinant for having visited a dentist during the previous year. Enabling factors, both organizational and individual, were emphasized. They seemed to enable service utilization particularly in the private sector.

Conclusions

Overall changes in the use of oral health care services were relatively small, but in line with the goals set for the reform. Older persons increased use of services in both sectors, implying growing need. Differences between public and private sectors persisted, and recall, costs of care and socioeconomic factors steered choices between the sectors, sustaining inequity in access to care.

Building Oral Health Research Capacity in India: Identifying Barriers and Enablers Using Mixed Methods

Knowledge Transfer Statement: This article will provide a brief overview of the methods in finding barriers and enablers in doing oral health research in India. This mixed-methods approach can be used by researchers in finding barriers and enablers in doing oral health research in other developing countries and building oral health research capacities.

Influence of children's oral health promotion on parents' behaviours, attitudes and knowledge

Objective The aim was to compare the changes in parents' oral health-related behaviour, knowledge and attitudes in 2001-2003 and 2003-2005, during a 3.4-year-intervention in Pori and in the reference area Rauma, Finland. Materials and methods The study population consisted of parents of children who participated in the oral health promotion programme in Pori (all 5th and 6th graders who started the 2001-2002 school year in the town of Pori, n = 1691) and the parents of same-aged children in a reference town (n = 807). In 2001-2003, the promotion was targeted only to the children in Pori. In 2003-2005, the promotion was targeted also to parents, for example via local mass media. The statistical significances of the differences in parents' self-reported behaviour, knowledge and attitudes, and changes in these, were evaluated using Mann-Whitney U-tests and confidence intervals. Results In 2001-2003, the trend in changing behaviours was in favour of parents in Pori. Mothers in Pori also improved their knowledge and the attitude 'importance of brushing for health and appearance'. In 2003-2005, the trend in changing behaviours was rather similar in both towns, which may be due to diffusion of the oral health intervention to Rauma via the media. Conclusions The results suggest that health promotion targeted to children, which in previous studies has been shown to be successful in improving children's behaviours, also helped their parents in mending their habits.

Oral health-related knowledge, attitudes and habits in relation to perceived oral symptoms among 12-year-old school children

Objective The aim of the study was to investigate oral health-related knowledge, attitudes and habits and their relationship to perceived oral symptoms among 12-year-olds and differences between boys and girls. Material and methods The study population consisted of children (n = 588) in 15 randomly selected elementary schools in Turku, Finland. Associations between oral health-related habits, knowledge and attitudes with perceived oral symptoms and gender differences were evaluated with χ(2)-test, Mann-Whitney U-test and logistic regression analysis. Results Oral health promoting habits but not knowledge or attitudes associated significantly with absence of oral symptoms. Girls reported a higher percentage of several health promotional habits than boys. Girls reported more frequently gingival bleeding and less frequently dental calculus than boys did. The most common oral symptom was gingival bleeding. Conclusions The present findings suggest some gender-related differences in oral health habits, attitudes, as well as perceived oral symptoms in 12-year-olds. There seems, however, not to be gender differences in relation to knowledge or the association of health habits with perceived oral symptoms. It is important to maintain health promotion at schools and additional efforts should be aimed at translating knowledge into action.

Can the results of the OSCE predict the results of clinical assessment in dental education?

INTRODUCTION

The aims of this study were to evaluate the correlation between the results of the objective structured clinical examination (OSCE) and clinical assessment and to test the reliability of OSCE test stations.

MATERIAL AND METHODS

All 4th year undergraduate dental students (n = 47, 100%) attended the OSCE in April 2010. The students were divided into two groups (morning group, group 1; afternoon group, group 2). Groups 1 and 2 were also divided into two subgroups that attended the stations in two concurrent sessions (A and B). The OSCE included 12 10-min test stations. Clinical assessment was based on long-term observation during the semesters. The disciplines assessed were cross-infection control, endodontics, paediatric dentistry, periodontology, prosthodontics and restorative dentistry.

RESULTS

Statistical analysis using Cronbach's alpha indicated good reliability of the OSCE. The correlation between the results of the OSCE and clinical assessment in the 4th year was statistically significant in cross-infection control (ρ = 0.340, P = 0.022), endodontics (ρ = 0.298, P = 0.047), prosthodontics (ρ = 0.296, P = 0.048) and restorative dentistry (ρ = 0.376, P = 0.011). Clinical assessment in the 5th year correlated with the OSCE results statistically significant in restorative dentistry (ρ = 0.522, P = 0.001).

CONCLUSION

Both the OSCE and constant longitudinal assessment are needed in clinical assessment, as they both play an important role in the overall assessment.

Changes in dental fear among Finnish adults: a national survey

OBJECTIVES

The aim of this study was to evaluate changes in dental fear among adult Finns aged 19 years and over at the beginning of the study in 2000-2011 in a nationally representative sample.

METHODS

The study was based on Health 2000 and 2011 Surveys by the National Institute for Health and Welfare in Finland. The Health 2000 Survey used a stratified two-stage cluster sampling design (N = 9 922). Those who participated in 2000 (n = 7 964) were invited to participate in 2011. The number of participants was 3 961. Dental fear was assessed by a single question: 'How afraid are you of visiting a dentist?' (not at all, somewhat, very much). Background variables included were age (categories 30-34, 35-39, 40-44, 45-54, 55-64, 65-74, 75+ years), gender, marital status (nonsingle, single), and education (basic, secondary, higher). To match the population sizes in different areas and thus forming a nationally representative data, the data were weighted based on age, gender, and area. General linear modeling for repeated measures was used to evaluate changes in dental fear and associations with background variables.

RESULTS

Between 2000 and 2011, dental fear decreased more often than increased among adults in Finland. Change from being very afraid to not at all afraid of visiting a dentist was most common in the oldest group. For most participants, dental fear remained stable; being very afraid of visiting a dentist was more stable among participants from 35 to 54 years of age than among younger or older participants.

CONCLUSIONS

Dental fear is still common among adult Finns and it seems to depend on age. As the most obvious consequence of dental fear is avoidance of dental care, reducing dental fear should be taken into account when planning and reorienting oral healthcare services.

Comparison of Oral Health-Related Quality of Life Among Schoolchildren With and Without Cleft Lip and/or Palate

OBJECTIVE

The aim was to compare the oral health-related quality of life among 11- to 14-year-old patients with cleft lip and/or palate (CLP) and schoolchildren without CLP. The validity and reliability of the Finnish Child Perception Questionnaire designed for 11- to 14-year-olds (CPQ11-14) was also assessed.

DESIGN AND SUBJECTS

Participants in this cross-sectional questionnaire survey study were children aged 11 to 14 years from two groups. The CLP sample included all children of this age who had had CLP selected from the regional treatment register (N = 51). The school sample included children from four school classes (N = 82). Informed consent from parents was obtained. Ethical clearance and parental informed consent were obtained.

MAIN OUTCOME MEASURES

Oral health-related quality of life was measured with the CPQ11-14.

RESULTS

The CPQ11-14 total and oral symptoms, functional limitations, emotional well-being, and social well-being subscores were poorer among patients with CLP than among schoolchildren without CLP (mean scores: 55.5 versus 15.0; 11.9 versus 5.1; 14.0 versus 2.8; 12.6 versus 4.2; and 17.1 versus 2.9, respectively; all P < .001 for Mann-Whitney tests). Cronbach alpha value was 0.97 for total scale and between 0.81 and 0.94 for subscales. Among all children in the school sample, intraclass correlation coefficient was 0.79 for total scale and varied between 0.65 and 0.74 for subscales.

CONCLUSION

The oral health-related quality of life of Finnish children with CLP was considerably poorer than that of their peers in overall and all dimensions, especially social well-being. The CPQ11-14 showed appropriate reliability and validity.