Barriers to the treatment of childhood caries perceived by dentists working in different countries

OBJECTIVE

To explore whether dentists' beliefs and attitudes to providing preventive and restorative dental care for young children can form a barrier to the provision of care.

BASIC RESEARCH DESIGN

The Barriers to Childhood Caries Treatment (BaCCT) Questionnaire, a standardised international measure was developed and applied.

PARTICIPANTS

Through a research consortium, each site was asked to recruit 100 dentists. The sample participating was not intended to be nationally representative. Dentists were mainly randomly selected and contacted by mail with one or more mailings depending on site.

RESULTS

2,333 dentists in 14 countries and 17 sites participated. Factor analysis identified four factors as potential barriers. Two factors were found to be barriers in many sites. First, in most countries, dentists agreed that young children's coping skills limit their ability to accept dental care. Secondly, dentists with negative personal feelings, for example, that providing care can be stressful and troublesome and that they feel time constrained. Differences in dentists' beliefs can be partly explained by their work profile, with those treating children often, and those working under systems where they feel they can provide quality care being least likely to identify barriers to providing care for children.

CONCLUSIONS

The BaCCT Questionnaire was determined to be a valid psychometric measure. Separately, it was found that health systems do impact on dentists' ability to deliver preventive and restorative care for children but that these effects vary across countries and further work is needed to determine how best these should be examined.

Familial and cultural perceptions and beliefs of oral hygiene and dietary practices among ethnically and socio-economicall diverse groups

OBJECTIVE; The aim of this international study was to develop a valid and reliable psychometric measure to examine the extent to which parents' attitudes about engaging in twice-daily tooth brushing and controlling sugar snacking predict these respective behaviours in their children. A supplementary objective was to assess whether ethnic group, culture, level of deprivation or children's caries experience impact upon the relationships between oral health related behaviours, attitudes to these respective behaviours and to dental caries.

CLINICAL SETTING

Nurseries, health centres and dental clinics in 17 countries.

PARTICIPANTS

2822 children aged 3 to 4 years and their parents.

MAIN OUTCOME MEASURES

Dental examination of children and questionnaire to parents.

RESULTS

Factor analysis identified 8 coherent attitudes towards toothbrushing, sugar snacking and childhood caries. Attitudes were significantly different in families from deprived and non-deprived backgrounds and in families of children with and without caries. Parents perception of their ability to control their children's toothbrushing and sugar snacking habits were the most significant predictor of whether or not favourable habits were reported. Some differences were found by site and ethnic group.

CONCLUSIONS

This study supports the hypothesis that parental attitudes significantly impact on the establishment of habits favourable to oral health. An appreciation of the impact of cultural and ethnic diversity is important in understanding how parental attitudes to oral health vary. Further research should examine in a prospective intervention whether enhancing parenting skills is an effective route to preventing childhood caries.

Caries risk children in the Danish child dental service

The purpose of the investigation was 1) to describe the progression and pattern of dental caries among Danish school children with high caries experience in relation to comparable groups of children with low or moderate levels of caries, and 2) to study the possibilities of early identification of risk children from information on caries experience in the mixed dentition. Longitudinal data from the Public Child Dental Service in a representative Danish municipality were used. Data on caries among children have been collected each year according to the standardized Danish recording system. In 1983/84, about 10% of the children with a high level of caries (H-group), and 10% with a low level of caries (L-group) were selected from all school children at grade 2 (n = 595), grade 5 (n = 658), and grade 8 (n = 631). Gradual increments of caries were observed for all three cohorts of H-groups. On average, caries on mesial and distal surfaces accounted for one fifth of the total caries experience in the permanent teeth and, in particular, molars were affected. In the primary dentition, caries on occlusal and on smooth surfaces accounted each for 40% of the caries experience. Caries in primary molars was dominating. Attempts were made to identify caries risk children at grade 8 from information on caries severity zone or from total caries experience at grade 1. Low values of predictive power were obtained. Therefore the relevance of sociomedical and sociological methods in the child dental service should be studied.