Caregivers' oral health literacy and their young children's oral health-related quality-of-life

Abstract

Objectives: To investigate the association of caregivers' oral health literacy (OHL) with their children's oral health related-quality of life (C-OHRQoL) and explore literacy as a modifier in the association between children's oral health status (COHS) and C-OHRQoL. Methods. This study relied upon data from structured interviews with 203 caregivers of children aged 3–5 from the Carolina Oral Health Literacy (COHL) Project. Data were collected for OHL using REALD-30, caregiver-reported COHS using the NHANES-item and C-OHRQoL using the Early Childhood Oral Health Impact Scale (ECOHIS). This study also measured oral health behaviors (OHBs) and socio-demographic characteristics and calculated overall/stratified summary estimates for OHL and C-OHRQoL. Spearman's rho and 95% confidence intervals (CI) were computed as measures of correlation of OHL and COHS with C-OHRQoL. To determine whether OHL modified the association between COHS and C-OHRQoL, this study compared literacy-specific summary and regression estimates. Results. Reported COHS was: excellent—50%, very good—28%, good—14%, fair—6%, poor—2%. The aggregate C-OHRQoL mean score was 2.0 (95% CI: 1.4, 2.6), and the mean OHL score 15.9 (95% CI: 15.2, 16.7). There was an inverse relationship between COHS and C-OHRQoL: ρ = ?0.32 (95% CI: ?0.45, ?0.18). There was no important association between OHL and C-OHRQoL; however, deleterious OHBs were associated with worse C-OHRQoL. Literacy-specific linear and Poisson regression estimates of the association between COHS and C-OHRQoL departed from homogeneity (Wald χ ² p < 0.2). Conclusion: In this community-based sample of caregiver/child dyads, a strong correlation was found between OHS and C-OHRQoL. The association's magnitude and gradient were less pronounced among caregivers with low literacy.     

Cultural factors and children's oral health care: a qualitative study of carers of young children

Objective: This qualitative study sought to identify cultural beliefs, practices and experiences that influence access to preventive oral health care for young children from different racial and ethnic groups. Methods: Four to six focus groups in each of the African–American, Chinese, Latino and Filipino communities in San Francisco, California were included in the study. Participants were carers of children aged 1–5 years. The 22 groups (n = 177 participants) were stratified by carer's age and, except in the African–American community, by whether US or non‐US born. Sessions were conducted in different languages as needed. Results: Lack of knowledge and beliefs about primary teeth created barriers to early preventive care in all groups. In Chinese groups more than others, health beliefs regarding disease causation and prevention influenced access to preventive dental care. In all groups, multiple family carers, especially elders, influenced access to preventive care. Dental fear, whether derived from prevailing community beliefs or personal negative dental experiences, greatly influenced attitudes regarding accessing preventive care. Conclusion: There are both similarities and differences between racial/ethnic groups in how cultural beliefs and experiences influence young children's access to dental care and how it might be improved.     

Rural Latino immigrant caregivers' conceptions of their children's oral disease

OBJECTIVE: The aim of this study was to examine Latino immigrant caregivers' explanatory models of the causes of early childhood caries (ECC). METHODS: In a rural area, we conducted 71 open-ended qualitative interviews with 26 Mexican immigrant and 12 Salvadoran immigrant caregivers of children under 6 about the causes of ECC. Two researchers independently read each interview and classified each interviewee's response. RESULTS: Caregivers mentioned three biomedical causes of oral disease (sweets, poor oral hygiene, and bottle-feeding) and two lay or popular causes (lack of milk consumption and "bad" genes). Although caregivers were aware that the consumption of sweet foods causes decay they expressed particular confusion about how bottle-feeding causes decay. Nineteen caregivers attributed decay specifically to bottle-feeding, yet 14 believed the cause of decay was the bottle's nipple. Seven Mexican immigrant caregivers attributed their children's decay specifically to a lack of calcium, and six immigrant caregivers to "bad teeth genes." CONCLUSIONS: Conceptions of oral disease derived from the caregivers' own dental experiences, their conceptions of the body, and interactions with dental professionals. The fact that biomedical explanations dominate the list of causes of caries for both groups indicates that the caregivers' explanatory models of oral disease are powerfully shaped by interactions with health professionals. Immigrant caregivers' mistaking of the baby bottle's nipple as the source of decay indicates the need for more effective oral health promotion. Yet the Mexican immigrants' conceptions of a lack of calcium as a major factor in their children's decay may illustrate a strong cultural link between teeth and milk.     

Prevention of early childhood caries: a public health perspective

This paper proposes strategies for preventing early childhood caries (ECC), preferably for the greatest number of children at the lowest cost. Population-based, public health approaches are more likely to reach the target population groups at risk of developing ECC than individual, private practice-based approaches. Different prevention and early intervention strategies are discussed and the following recommendations are made: 1) Continue to promote community water fluoridation. 2) Evaluate the effectiveness of other public health oriented measures to prevent ECC. 3) Develop a national ECC and rampant caries registry. 4) Link oral health screening and easily implemented, low-cost interventions with immunization schedules and public health nursing activities. 5) Increase opportunities for community-based interventions conducted by dental hygienists. 6) Change insurance reimbursement schedules to provide incentives for dentists to prevent disease. 7) Include dentistry in new child health insurance legislation for children as well as parents of infants and preschool children.     

A three-year retrospective study of emergency visits at an oral health clinic in south-east Queensland

Background: There is little information available regarding dental emergencies for children in Australia. The aim of this study was to investigate the reasons for dental emergency cases which were treated at a public oral health clinic in a low socioeconomic district in south‐east Queensland. Methods: From a register kept at a public oral health clinic, we analysed the monthly number of emergency visits for children over a three‐year period (January 2008 to August 2010) with respect to numbers treated, reasons for presentation and types of treatment rendered. Results: During the period 2008–2010, there was a mean of 196 ± 86 cases presenting for emergency care each month. The proportions of the various types of emergencies remained fairly consistent over the three‐year period, with the majority presenting for caries related problems (74–75%), followed by trauma (8–9%), orthodontic treatment related (2–5%) and other reasons (16–11%). Between 8–11% of cases were preschool children who were added to the waitlist for treatment for caries under general anaesthesia at the public hospital. Conclusions: Trends in the past three years at a public oral health clinic in a low socioeconomic district in south‐east Queensland show that dental caries constitute nearly three‐quarters of all paediatric emergency appointments.     

1826名大学生口腔健康状况调查

目的：调查大学生口腔健康状况,指导大学生口腔保健。方法：按照WHO1997年制定的口腔健康调查基本方法,调查1826名大学生的的龋病、牙结石和第三磨牙萌出情况。结果：大学生的患龋率为43.37%,龋均1.82,龋齿充填率25.66%;患龋情况女生比男生严重、城市学生比农村学生严重（p〈0.01）;牙结石检出率为80.07%,平均区段数为3.97,牙结石检出情况男生比女生严重,农村学生比城市学生严重（p〈0.01）;第三磨牙萌出率为37.79%,城乡和性别上的差异均无统计学意义（p〉0.05）。结论：大学生口腔健康状况不佳,应重点防治龋病、牙周病和智齿冠周炎。     

Using insurance claims and demographic data for surveillance of children's oral health

OBJECTIVES: This paper examines the utility of using private insurance and Medicaid dental claims as well as demographic data for assessing the oral health of children aged 5-12 years in Genesee County, Michigan, communities. METHODS: Dental insurance claims data from Delta Plan of Michigan and Michigan Medicaid, plus demographic data from the 1990 US Census (percent poverty) and from the 1995 National Center for Educational Statistics (percent free or reduced lunch eligibility), were compared to findings from two school-based oral health surveys. These surveys were the 1995 Genesee County Oral Health Survey and the 1998-2001 Mott Children's Health Center oral health screenings. Data were analyzed using zip codes, representing communities, as the comparison unit. Statistical comparisons using correlation coefficients were used to compare the findings from the six data sets. RESULTS: Using the insurance claims and school-based data, some communities consistently demonstrated high levels of dental caries or treatment for the primary dentition. The demographic measures were significantly associated with many of the primary dentition survey measures. The demographic data were more useful in identifying communities with high levels of dental disease, particularly in the primary teeth, than the insurance claims data. CONCLUSIONS: When screening is not practical, readily available demographic data may provide valuable oral health surveillance information for identification of high-risk communities, but these data do not identify high-risk individuals. In these analyses, demographic data were more useful than dental insurance claims data for oral health surveillance purposes.     

Oral health status and dental needs of autistic children and young adults

Aim: Children with autism might need more dental care than non‐autistic, healthy children. The aims of this study were: (a) to describe the caries experience and treatment needs of autistic children aged 6–16 years in the United Arab Emirates; and (b) to provide baseline data at national and regional levels to enable comparisons and future planning of dental services for children with autism. Methods: All children attending a day centre in Sharjah, United Arab Emirates, for autism were selected for the study. Sixty‐one autistic children aged 6–16 years (45 males and 16 females) were included in the study. Each patient received a complete oral and periodontal examination using codes and criteria as described by the World Health Organization. Results: The overall mean for Decayed, Missing, and Filled Teeth/decayed, missing, and filled teeth was 2.4. Female autistic children had significantly higher mean Decayed, Missing, and Filled Teeth/decayed, missing, and filled teeth scores (4.4) than males (1.63). The percentage of decayed, missing, and filled teeth increased with increasing age. The restorative index and met need index for the autistic children aged 11–15 years were 0.02 and 0.10, respectively. Conclusion: Effective oral health promotion strategies need to be implemented to improve the oral health status of autistic children.     

Effect of regular small group instruction per se on oral health status of Danish schoolchildren

A 1-year study of the isolated effect of an intensive motivation program aimed at improving the oral health status of 11-13-year-old schoolchildren was conducted in a Danish provincial town where all children have access to a free and comprehensive school oral health program. The effect was negligible as measured by epidemiologic indices.     

Child and family health nurses' experiences of oral health of preschool children: a qualitative approach

Objectives: The objective of this study was to explore Child and Family Health Nurses' work‐related experiences of dental disease in young children. Methods: Child and Family Health Nurses (n = 21) who recruited new mothers to an ongoing birth cohort study that began in South Western Sydney, Australia were invited to take part in a qualitative study. A semi‐structured, in‐depth interview technique was used to explore their experiences of preschool child oral health and how this affects their working lives. Interviews were audio‐recorded, transcribed verbatim, and analyzed using a thematic analysis. Results: The nurses considered dental caries to be a significant health issue for young children and their families. They thought that the burden of dental disease in preschool children was underestimated in disadvantaged and multicultural populations. In addition, they reported that parents were often unaware of the disease process and were ignorant of the relationship between bottle feeding and dental caries. Once the parents were informed about their child's poor oral health, they had feelings of anger, despair, and guilt. Conclusions: This study highlights that oral health problems are a significant segment of the child health problems identified by nurses in their daily work. The nurses perceived the problem of dental caries to be one of a lack of parental knowledge, and families should be educated not only on “what” but also on “how” to feed their children. The primary healthcare team should work collaboratively to educate families in a culturally appropriate way.     

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目的 调查医科大学新生口腔健康状况以指导大学生口腔保健.方法 于2010年6月按照世界卫生组织《口腔健康调查基本方法》(第4版)的原则并参考第三次全国口腔健康流行病学调查方案,对中国医科大学723名新生的口腔健康状况进行普查,应用SPSS13.0统计软件对新生的患龋及牙周疾病情况进行统计分析.结果 (1)723名大学生的患龋率为56.98％,龋均为2.19,龋充填率为29.40％;女性大学生、城镇大学生的患龋情况较男性大学生、农村大学生严重.(2)723名大学生的牙石检出率、牙龈出血检出率和牙周袋检出率分别为78.28％、64.32％和6.22％;男性大学生、农村大学生的牙石检出率、牙龈出血检出率情况较女性大学生、城镇大学生严重.结论 医科大学新生口腔健康状况不佳,需加强对大学生口腔疾病预防及口腔保健的宣传,提高大学生口腔健康状况水平.