An oral health promotion programme for nursing caries

Aim . To evaluate an oral health promotion programme involving health visitors and mothers of 8-month-old babies in order to address some of the risk factors associated with nursing caries.
Design . Two cross-sectional studies using postal questionnaires.
Sample . A random sample of 250 mothers who had not received the oral health promotion programme and 250 mothers who had received the programme.
Setting . The City of Salford.
Results . The oral health promotion programme significantly improved mothers recall of advice given by health visitors encouraging the use of a feeder cup, brushing their babies' teeth with fluoride toothpaste and restricting sugary foods and drinks. Significant improvements were also found in recall of advice regarding the use of sugar-free medicine and registering babies with a dentist. The programme encouraged a higher proportion of the mothers to bring their children to clinics for a hearing check.
Conclusion . A simple oral health promotion programme facilitated by health visitors improved recall of advice and clinic visiting behaviour.     

Oral health behaviour of 12-year-old children in Kuwait

Objectives . The objectives of the study were: (1) to describe the pattern of oral health behaviour of 12-year-old children in Kuwait, (2) to analyse this in relation to parental education, dental visiting habits and location, and (3) to establish a baseline for planning and evaluation of an oral health care programme for secondary schoolchildren.
Design . Cross-sectional, interviews with children in 1995.
Sample and methods . The sample included 500 12-year-old schoolchildren (250 boys and 250 girls) selected from schools in Kuwait. All the children agreed to take part. Interviews with the children were carried out in the schools by four trained and calibrated Arabic speaking interviewers.
Results . During the previous 12 months, 28% of the children had experienced oral health problems – toothache (10%), or had felt discomfort (18%) either often or occassionally. The children reported that they needed oral hygiene instruction (71%), fillings (32%) and tooth extraction (23%). For 53% of the children the reason for the most recent visit to a dentist was pain or problems with teeth or gums. At their last dental visit 26% of the children had undergone a tooth extraction. The consumption of sugary foods and drinks was extremely high. Children who had visited a dentist within the last 12 months and children whose parents had higher education levels more often claimed frequent toothbrushing than those with no previous dental visiting experience and those whose parents had a low level of education.
Conclusions . Oral health education and oral health care programmes should be established in secondary schools in Kuwait to influence the oral health behaviour of the children and to avoid further deterioration in their oral health.     

Parental perspectives on preterm children's oral health behaviour and experience of dental care during preschool and early school years

Background.  Children born preterm (PT) have medical conditions and impairments that may affect their oral health.
Hypothesis.  Our hypothesis for the study was that PT children display more dental behaviour management problems (BMPs) and less favourable oral health behaviour than controls (C).
Methods.  Parents of 153 PT children and 153 C children were interviewed regarding the children's oral health behaviour and experience of dental care on two occasions, 2 years apart. The interviews concerned the preschool period and the early school years, respectively.
Results.  BMPs were more common in PT children of preschool age, but not during the early school years. Regarding oral health behaviour, there were no differences between the groups, except that PT children had more problems with toothbrushing than C children in the preschool period, in spite of the fact that the PT group reported more medical health problems and more anxious behaviour and indications of cognitive problems than the C group.
Conclusions.  Children born PT exhibit several risk factors for both BMP and impaired oral health. It is essential that this group of patients is identified early and receives special attention from the dental services.     

Dental hygiene work in a clinical trial

Abstract:  Dental hygiene activities were developed as part of a randomized clinical trial designed to assess the safety of low-level mercury exposure from dental amalgam restorations. Along with dental-hygiene clinical work, a community programme was implemented after investigators noticed the poor oral hygiene habits of participants, and the need for urgent action to minimize oral health problems in the study population.
Objectives:  Clinical and community activity goal was to promote oral health and prevent new disease. Community activities involved participants and their fellow students and were aimed at providing education on oral health in a school environment.
Methods:  Dental hygienists developed clinical work with prophylaxis, sealants application and topical fluoride and implemented the community programme with in-class sessions on oral health themes. Twice a month fluoride mouthrinses and bi-annual tooth brushing instructional activity took place. Participation at dental-hygiene activities, sealed teeth with no need of restoration and dental-plaque-index were measures used to evaluate success of the programme for the participants.
Results:  Improvement in dental hygiene is shown by the decrease in dental plaque index scores ( P  < 0.0001); also sealants integrity is achieved in 86.3% of teeth. 888 (13.7%) teeth with sealants had to be restored or were lost. Children participated actively on dental hygiene activities. Teachers became aware of the problem and included oral-health in school curricula.
Conclusion:  Dental hygiene activities have shown to be helpful to promote dental hygiene, promote oral health and to provide school-age children with education on habits that will be important for their future good health.     

Dental caries in schoolchildren of an Estonian and a Danish municipality

Objectives . The objectives of the study were to describe the prevalence rate and the severity of dental caries in Estonian schoolchildren aged 7 and 12 and to compare the findings with those of Danish children.
Design . Cross-sectional surveys in Estonia and Denmark, clinical oral examinations of children in 1997.
Samples and methods . In Estonia, 195 children aged 7 and 215 children of age 12 were selected in the municipality of Tartu in schools identified for oral health promotion projects. In Denmark, the study included 637 7-year-olds and 642 12-year-olds living in the municipality of Horsens and served by the Public Dental Health Service for children. All children in the two countries were examined by calibrated dentists for dental caries according to the Recording System for the Danish Public Dental Health Service.
Results . At age 7, 83·8% of Estonian children had dental caries (7·7 dmfs) against 62·1% of Danish children (5·3 dmfs). At age 12, the mean caries experience was 2·1 DMFS in Estonia against 1·3 DMFS of the Danish children. Most of the caries indices were due to the high d/D components and approximal caries was prominent. In the study area in Estonia, the content of fluoride in drinking water was optimal (0·8–1·5 p.p.m.) whereas the level of fluoride was low in the Danish municipality (0·2 p.p.m.).
Conclusion . In the Baltic states, the oral health systems are in transition. For the continuous improvement of oral health in childrens' reorientation of services should consider implementation of community-based oral health promotion and the schools provide an excellent setting for preventive oral care.     

The effectiveness of a 6-year oral health education programme for primary schoolchildren

OBJECTIVES: The aim of this study was to evaluate the effect of a 6-year oral health education programme in primary schoolchildren. METHODS: This programme was part of the Signal-Tandmobiel project, a longitudinal collaborative project combining the registration of oral health data and oral health promotion. The intervention group comprised 3291 children with a mean age of 7.1 years (SD 0.43) at the start of the programme. Every year these children were examined clinically and a questionnaire, to be filled in by the parents, was administered to assess oral health behaviour. These children received an oral health education programme which consisted of a yearly 1-h instruction. Data collected using the same questionnaire and clinical examination in 676 12-year-old children were included as control group. The samples were obtained using stratified cluster sampling. The effect of the interventional programme was assessed by measuring differences in caries prevalence and incidence, levels of dental care and reported oral health behaviour. RESULTS: Mean DMFT/S values, although higher in the control group, were not significantly different. The reported frequency of brushing was the same in both groups. Significant differences in favour of the intervention group were found in the number of between-meal snacks (P < 0.001) and the proper use of topical fluorides (P < 0.05). Children in the control group showed a significantly lower proportion of filled teeth than those in the intervention group (P < 0.01), with a care index of 73% versus 80%.CONCLUSION: In conclusion, the implemented minimal school-based oral health education programme did not result in a significant reduction of the caries prevalence measured. The programme has been effective in improving reported dietary habits and the proper use of topical fluorides and resulted in a higher care index.     

The development of a national oral health promotion programme for pre-school children in England.

Dental caries amongst pre-school children remains a significant dental public health problem in the UK. The well-developed and extensive treatment and preventive services in the UK have failed to effectively prevent dental caries in a significant proportion of pre-school children, especially within disadvantaged communities. This paper outlines the development of an innovative national oral health promotion programme in England which has targeted the carers of pre-school children attending day care facilities. Extensive background research informed the approach of the programme and the resource requirements. Particular emphasis in the programme has been on the development of policies and guidelines in day care settings that promote oral health. Key features of the programme have been the integration of oral health and nutrition, and joint working across sectors and professional disciplines. An evaluation framework, which outlines a range of outcome measures that can be used to assess the effects and impact of the programme, is also described.     

Increasing dental care utilization by Medicaid-eligible children: a dental care coordinator intervention

Objectives: The aim of this study was to determine the effect of a dental care coordinator intervention on increasing dental utilization by Medicaid-eligible children compared with a control group.
Methods: One hundred and thirty-six children enrolled in Medicaid aged 4 to 15 years at baseline in 2004 who had not had Medicaid claims for 2 years, were randomly assigned to intervention or control groups for 12 months. Children and caregivers in the intervention group received education, assistance in finding a dentist if the child did not have one, and assistance and support in scheduling and keeping dental appointments. All children continued to receive routine member services from the dental plan administrator, including newsletters and benefit updates during the study.
Results: Dental utilization during the study period was significantly higher in the intervention group (43 percent) than in the control group (26 percent). The effect was even more significant among children living in households well below the Federal Poverty Level. The intervention was effective regardless of whether the coordinator was able to provide services in person or via telephone and mail.
Conclusion: The dental care coordinator intervention significantly increased dental utilization compared with similar children who received routine Medicaid member services. Public health programs and communities endeavoring to reduce oral health disparities may want to consider incorporating a dental care coordinator along with other initiatives to increase dental utilization by disadvantaged children.     

Oral health programme for preschool children: a prospective, controlled study

Background.  New perspectives are needed for oral health programmes (OHPs). The aim was to evaluate the preventive effect of a risk-based OHP in comparison with a traditional programme.
Design.  An age cohort of 794 Finnish children, 446 in the intervention group and 348 in the control group, was followed from 18 months to 5 years of age. The children were screened for mutans streptococci (MS) in the dental biofilm. The main outcome measure was the proportion of children with dental caries (decayed, missing, or filled primary teeth > 0) at the age of 5 years. The intervention, targeted to MS-positive subjects in the intervention group only, was based on repeated health education to the caretakers and xylitol lozenges for the child. Dental hygienists carried out the programme.
Results.  OHP was effective in white-collar families [numbers needed to treat (NNT) = 3, 95% CI 2–11]. Factors significantly associated with caries at 5 years were MS colonization at 18 months, occupation of caretaker, but also gender when incipient carious lesions were included in the index.
Conclusion.  Early risk-based OHP, targeted to the families of MS-positive children, can reduce the risk for caries in white-collar families. For blue-collar families, different kinds of methods in caries prevention and support are needed.     

Efficacy of an oral health promotion intervention in the prevention of early childhood caries

Abstract – Objective: Despite a marked improvement in oral health of Australian children over the last 30 years, severe early childhood caries (S‐ECC) affects up to 17% of 2‐ to 3‐year‐old children with some requiring hospitalization and invasive treatment. This provided a compelling rationale to develop and test an oral health promotion programme which aimed to reduce this unnecessary suffering. The purpose of this study was to test the efficacy of an oral health promotion programme for the parents of infants, starting during the pregnancy, using a randomized controlled trial. Methods: A programme was developed around the provision of anticipatory guidance to nulliparous women (women expecting their first child) in Adelaide. Mothers in the test group received oral health promotion information during pregnancy, and later when the child reached 6 and 12 months of age. After the second round of information the test group mothers were randomized again. The information was reinforced in one of the test subgroups through a telephone consultation. There was no contact with mothers in the control group after enrolment. At the age of 20 ± 2.5 months all test and control group children were examined by a dentist. The case definition of an incidence of S‐ECC was one or more upper incisor teeth being carious at the level of a cavitated or noncavitated lesion. The differences in S‐ECC incidence between the test and control groups, and the test subgroups were analysed. Results: Of 649 women enroled in the programme (test group 327, control group 322), 441 had their child examined at follow‐up. The incidence of S‐ECC in the test group was 1.7% and in the control group 9.6% (P < 0.001). Conclusion: An oral health promotion programme based on repeated rounds of anticipatory guidance initiated during the mother’s pregnancy was successful in reducing the incidence of S‐ECC in these very young children.     

Dental caries prevalence and dental health behaviour in HIV infected children

Objectives . To determine dental caries prevalence in a group of HIV positive children and their reported dental health behaviour.
Design . Standardized epidemiological dental examination and structured interview.
Setting . Paediatric HIV outpatient department in a South London hospital.
Study population . HIV-positive children attending the above outpatient clinic over a 6-month period (30 subjects) and parents (20 informants).
Methods . Epidemiological examination of children was undertaken by one trained and calibrated examiner to determine caries prevalence using dmft/DMFT. Parents were interviewed to obtain information on their children's dental health behaviour: tooth-brushing, diet, fluoride; oral medication and dental attendance were explored.
Results . Sixty-three per cent ( n  = 19) of children had dental caries experience, much of it untreated. Mean dmft/DMFT was 4·4. Sixty per cent ( n  = 18) of all children presented with active or untreated caries and the care index for those at/under age 5 years was low (10%). Unfavourable dental health behaviour included: consumption of nonmilk extrinsic sugars at night, use of sugar-based medications, low fluoride intake, late commencement of toothbrushing and poor dental attendance. Dental health was not considered a priority for many of these children. Parents did not necessarily disclose their child's HIV status on dental attendance.
Conclusion . Caries prevalence was high, much of the disease untreated, and unfavourable dental health behaviour, including the use of sugar-based medicines was common. HIV infected children should be considered a high caries risk and receive appropriate dental care, in terms of both treatment and preventive services, following confirmation of seropositivity.     

An investigation of the oral status and reported oral care of children with heart and heart-lung transplants

Aim . To investigate the oral health status and oral microflora of children who have received heart and heart-lung transplants. Parental knowledge and current practice of oral health procedures by the child were also investigated.
Sample and method . Thirty-five children attending the Cardio-Thoracic Transplant Unit, Great Ormond Street Hospital for Children were included. Measurements were compared with children matched by age and gender attending the trauma clinic at the Department of Paediatric Dentistry, Eastman Dental Hospital. Teeth were examined for the presence or absence of caries or enamel defects. Plaque deposition, gingivitis, gingival bleeding and gingival enlargement were measured and a swab was taken to look at the oral microbial flora. A questionnaire was used to assess parental knowledge of dental health procedures and the current practice of these.
Results . There were no significant differences between transplant and control children in caries experience, plaque or gingivitis. Children with heart or heart-lung transplants had significantly greater numbers of enamel defects and more gingival enlargement than control children, children in the heart transplant group had significantly more gingival bleeding. There was little difference in the dental knowledge and reported behaviour of the transplant group compared to the control group.
Conclusion . The dental needs of heart and heart-lung transplant patients treated at the Great Ormond Street Hospital for Children were similar to those of the control group in this study, however further improvement could be made in educating parents and children on the importance of caries prevention and good oral hygiene.     

An investigation into the value and relevance of oral health promotion leaflets for young adolescents

OBJECTIVES: To determine if oral health promotion leaflets of a novel design and content would be read by, acceptable to and influence 11-12-year-old children. METHOD: Three related leaflets were incorporated into a dental health education programme aimed at 11-12-year-old children. The leaflets were designed specifically, following consultation with focus groups. They had a romantic story line and emphasised the immediate gains from good dental health, relevant to this age group. A random sample of pupils completed a written questionnaire on the impact of the leaflets at the end of the one-year programme. These sample pupils underwent a clinical examination to measure plaque before and after the programme. RESULTS: 2,678 pupils with a mean age of 12.1 years participated in the programme. 895 were randomly selected to join the assessment study. Most pupils 81%, (725) reported they had read the leaflets; 61% (442) finding them enjoyable to read, 51% (370) attractive to look at and 71% (515) finding the story lines interesting. However, girls appreciated the leaflets more than the boys. There was some suggestion that the leaflets played a positive role in the overall success of the programme in that most pupils 83% (602) reported they thought more about caring for their teeth after reading the leaflets and 58% reported their brushing frequency had increased. CONCLUSION: The results indicate that for adolescents, leaflets which feature interpersonal relationships are well accepted and can stimulate better oral health behaviour.     

Glasgow nursery-based caries experience, before and after a community development-based oral health programme's implementation

OBJECTIVE: To develop and evaluate NHS-based strategies likely to improve dental health and reduce inequalities in pre-5-year-old's oral health in Greater Glasgow, Scotland, by ecological study of community-based oral health promotion programmes in two of the area's most socio-economically deprived communities. BASIC RESEARCH DESIGN: Following an initial health service-based Oral Health Needs Assessment (OHNA) in a severely deprived community, culturally relevant dental health promotion interventions were initiated with multidisciplinary collaborative networks. Ecological studies to monitor dental health involved cross-sectional caries epidemiology of nursery children aged 36-59 months at baseline (1995/96), after two (1997/98) and four years (1999/00), in the G22 (pilot) and G33 post code areas. These areas had similar socio-economic status (SES), i.e. severe social deprivation. RESULTS: At the outset, mean dmft scores in the pilot area for the age groups 36-47 months and 48-59 months were respectively 3.9 (95% CI 2.8 5.1) and 5.9 (95% CI 5.1-6.8), with the proportions of caries-free children being 38% and 17%, respectively. Reductions in mean dmft of 46% for the 36-47 month-olds and 37% for the 48-59 month-olds occurred in the pilot public health programme area over the four-year period; the proportions of caries-free children increased to 51% and 40%, respectively. During the first two years of the programme, increases in the mean dmft of 36-47 month- and 48-59 month-olds in the G33 (comparator) area were recorded. However, this trend was reversed significantly two years later following the introduction of a similar community development-based caries-prevention programme. CONCLUSION: While not being able to attribute causation, a programme of community development to promote the dental health of pre-school children residing in two socio-economically disadvantaged areas of Glasgow was associated with significant improvements in the dental health of these pre-school populations.     

Could a national oral health promotion program improve the oral hygiene of persons attending special care establishments in France? Evaluation of a pilot program

This study aimed to investigate the effectiveness of an oral health promotion intervention implemented in special care establishments by dentists trained online. Twenty‐six dentists intervening in 27 French special care establishments undertook a standardised oral health promotion intervention, including a conference presentation for care staff and hands‐on toothbrushing workshops. Oral hygiene status of the residents was performed at baseline and at 6 months, and were compared using the McNemar test. Mixed logistic regression was performed to identify the factors associated with an improvement of dental plaque removal. The oral health intervention was completed by 890 residents: 445 children, 373 adults and 72 elderly adults. At baseline, dental plaque was observed for 79.8% of the 797 dentate residents. Among the 691 dentate residents included in the final analysis, dental plaque removal was improved for 34%. Improvement in dental plaque removal was recorded more often for the group of 13 to 20‐year‐old residents (OR = 1.97; 95% CI = 1.15–3.38). The results indicate that this programme failed to significantly improve the dental plaque removal of the residents. More research is needed to understand the limiting factors of such interventions.     

An oral health education programme based on the National Curriculum

AIM: The aim of this study was to develop and evaluate a teaching programme based on the national curriculum for use in a primary school setting. DESIGN: National Curriculum guidelines were combined with oral health education messages to draw up lesson plans for teachers to deliver. A questionnaire was used to demonstrate children's oral health knowledge prior to the teaching programme, and at 1 and 7 weeks following the programme. The study took place in inner-city, state-run primary schools in Manchester and North London, UK. The subjects were children between the ages of 7 and 8 years from Manchester (n = 58) and North London (n = 30). The main outcome measure was change in knowledge attributable to a newly developed teaching programme. RESULTS: The children in Manchester had a higher level of knowledge prior to the teaching programme. Following the teaching programme, children in both schools showed a significant improvement in dental health knowledge (P < 0.001). Seven weeks later, the Manchester children showed no significant loss of knowledge (P < 0.001). CONCLUSIONS: The aims of the National Curriculum were easily integrated with oral health messages. A more widely available teaching resource, such as the one described in this study, would be useful to encourage the teaching profession to take on oral health education without more costly input from dental professionals.     

Do maternal factors influence the dental health status of Nigerian pre‐school children?

Objective.  This study was designed to investigate the relationship between maternal related factors and the dental health status of pre-school children in Lagos State, Nigeria.
Methods.  A cross-sectional study of 404 pairs of mothers and their pre-school children was conducted at two selected primary health centres in Lagos State Nigeria. An interviewer administered questionnaire recorded the mother's socio-demographic characteristics and assessed her perception of her child's dental needs, attitude to oral disease prevention, level of dental health knowledge and attitude to oral health. The child's dental status was assessed using the dft index (caries status) and the simplified oral hygiene index. Data analysis tools included Spearman's correlation coefficient and multivariate logistic regression.
Results.  Maternal age, maternal education, location of residence, maternal knowledge, and attitudes were all positively correlated with the child's caries and oral hygiene status. There were statistically significant correlations between maternal attitude and the oral hygiene index ( P  = 0.01) and dft score ( P  = 0.001). Maternal age also had a significant relationship with the child's caries status ( P  = 0.003).
Conclusion.  This study concluded that maternal age and attitude were important determinants of caries experience whereas the mother's attitude was an important determinant of oral cleanliness in pre-school children in Lagos State Nigeria.     

Development of a rural outplacement programme for dental undergraduates: students' perceptions

Objectives:  To describe the development and implementation of a new rural dental outplacement module in the final year curriculum and report initial student perceptions.
Methods:  The Melbourne Dental School, University of Melbourne, introduced a required 4-week rural outplacement [termed Rural Dental Rotation (RDR)] in July 2006 to provide education and clinical training to all final year students. Seventy dental students (Bachelor of Dental Science and Bachelor of Oral Health) were rostered in groups of 6—10 students to Shepparton (Victoria, Australia), from July 2006 to June 2007 for 4 weeks per group. Students were introduced to the culture and oral health needs of the indigenous population in the region, and were involved in oral health promotion in specific health programmes. At the end of each roster students provided feedback of their experiences through a voluntary anonymous questionnaire.
Results:  The RDR offered a rural learning experience to all final year dental undergraduates and also provided dental services to the local community on a continuing basis. Students agreed that the RDR was a worthwhile experience (mean 4.77 ± 0.46 on 1—5 scale) and was 'enjoyable' (mean 4.71 ± 0.45). There was only one student who did not consider rural practice in future. This was because of family reasons. The majority (79.1%) expressed definite affirmation, whereas some (19.4%) indicated the possibility of taking up rural practice.
Conclusions:  Overall feedback indicated that the students found it a very positive and enjoyable experience. It provided an opportunity to appreciate cultural safety and understand the specific oral health needs of indigenous Australians. The key benefit of such a programme to the community is the increased likelihood of attracting new dental graduates to rural areas.     

Why are children still having preventable extractions under general anaesthetic? A service evaluation of the views of parents of a high caries risk group of children

Introduction Despite overall improvements in oral health, the number of children admitted to hospital for extraction of teeth due to caries under general anaesthesia (GA) has been reported as increasing dramatically in England. The new UK government plans to transform NHS dentistry by improving oral health.Aim To evaluate the dental care received by children who required caries-related extractions under GA and obtain the views of their parents or guardians on their experiences of oral health services and the support they would like to improve their child's oral health, to inform future planning.Method An interview questionnaire was designed and piloted to collect data from a consecutive sample of 100 parents or guardians during their child's pre-operative assessment appointment. This took place at one London dental hospital between November 2009 and February 2010.Results Most children were either white (43%) or black British (41%); the average age was seven years (range 2-15, SD 3.1, SE 0.31) and the female:male ratio was 6:5. Most (84%) had experienced dental pain and 66% were referred by a general dental practitioner (GDP). A large proportion of parents or guardians (47%) reported previous dental treatment under GA in their children or child's sibling/s. Challenges discussed by parents in supporting their child's oral health included parenting skills, child behaviour, peer pressure, insufficient time, the dental system and no plans for continuing care for their child. Three out of four parents (74%) reported that they would like support for their child's oral health. Sixty percent of all parents supported school/nursery programmes and 55% supported an oral health programme during their pre-assessment clinic.Discussion These findings suggest that the oral health support received by high caries risk children is low. Health promotion programmes tailored to this cohort are necessary and our findings suggest that they would be welcomed by parents.