Caries Incidence Is Associated with Wasting among Cambodian Children

Evidence suggests that dental caries is associated with chronic and acute malnutrition, manifested as stunting and wasting in children. However, studies have not always appropriately accounted for confounding factors or for the temporal ordering between exposure and outcome. This study examined relationships between the development of caries lesions with subsequent stunting and wasting outcomes using data from a population-based cohort in Cambodia. Caries incidence was assessed based on the presence of a new cavitated carious lesion or a new pulpally involved lesion across a 6-mo observation period. Anthropometric measurements were taken at regular intervals. Effects of carious lesions on stunting and wasting were assessed using inverse probability treatment weighting, adjusting for potential confounders, using z scores for height-for-age (HAZ) and weight-for-height (WHZ) as outcomes. In total, 894 children (mean age 20 mo at baseline) were followed over 2 y. At baseline, 350 (39.1%) were identified as having stunting malnutrition. At follow-up, 58 (6.5%) had a new pulpally involved lesion. There was no association between incidence of cavitated or pulpally involved carious lesions at follow-up and stunting (relative risk [RR] = 1.06; 95% confidence interval [CI]: 0.75, 1.50). The incidence of pulpally involved carious lesions had an effect on wasting prevalence (WHZ <-2; RR = 1.35; 95% CI: 0.70, 2.62) and WHZ scores (average treatment effect = -0.294; 95% CI: -0.538, -0.050). This study offers evidence that the development of pulpally involved carious lesions has an effect on WHZ scores. Oral health promotion and clinical prevention and management of dental caries should be explored as interventions to promote normal growth and development among preschool children, particularly in low-income settings.

The effect of improving oral health literacy among teachers on the oral health condition of primary schoolchildren in Cambodia

AIM

In Cambodia, civil unrest has led to insufficient and inaccessible dental health services. Oral health education and awareness are lacking, thus childhood dental caries is highly prevalent. This study aimed to examine the effects of an oral health education programme for public primary school teachers on the pupils' oral health.

METHODS

Between 2011 and 2015, an oral health education workshop was presented annually to primary school educators employed at a public school in Siem Reap, Cambodia. Oral screenings of 2,637 pupils (grades 1-6; subdivided between the lower 1-3 and upper 4-6 grades) were undertaken and the prevalence of dental caries, mean number of DFT, and mean percentage of DFT rate were calculated.

CONCLUSION

Despite the persistently high prevalence of dental caries, the oral health status of the schoolchildren improved every year. Participation in the workshops may have improved the teachers' ability to provide oral healthcare instructions, leading to the reduced dental caries prevalence among pupils.

Improving the provision of the Basic Package of Oral Care (BPOC) in Cambodia

Since 1992, 330 medical nurses have been trained to provide basic oral health care (including ART restorations and dental extractions) in remote areas of Cambodia. However, a range of barriers prevent dental nurses from providing these services, especially a lack of dental materials and instruments.

OBJECTIVES

To increase dental nurse (DN) outputs through the regular provision of dental materials and instruments. To improve cross-infection control procedures through the provision of necessary equipment, supplies and training.

METHODS

Six health centres with active DNs participated; three (experimental) health centres received sufficient supplies of dental instruments and materials for one year, and 3-monthly visits by a dentist from the Ministry of Health. The other three health centres (control) did not.

RESULTS

During the project period, the experimental group extractions increased to an average of 119 extractions per quarter (a three-fold increase compared to the baseline), 51 ART restorations, and improved compliance with cross-infection infection control protocols. In the control group the number of extractions remained similar to baseline and no ART restorations were placed.

CONCLUSIONS

The provision of the BPOC increased in the health centres when sufficient supplies of dental materials and instruments were provided. Increased monitoring and communication with MOH dental colleagues was also associated with the increased outputs and resulted in improved compliance with cross-infection control protocols. The MOH should increase supplies to DNs and provide ongoing monitoring and support in order to improve the access to and quality of dental care provided in rural Cambodia.