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.     

Examining the accuracy of caregivers' assessments of young children's oral health status

BackgroundCaregivers' perceptions of their young children's oral health status (OHS) are a strong determinant of whether the children visit a dentist. Our aims were to quantify the correlation between caregivers' assessments and their children's clinically determined restorative treatment needs, while investigating factors related to this association.MethodsOne hundred eight caregivers assessed their children's OHS by answering a question on the self-reported National Health and Nutrition Examination Survey III instrument. Children underwent clinical oral examinations at one of two study sites of the Carolina Oral Health Literacy Project: a dental school–based clinic and a community-based health clinic. Examiners recorded the children's clinical treatment needs by using a modification of the caries severity index. The authors quantified concordance between the two measures with use of the Spearman rank correlation (ρ) and Kendall τ rank correlation, whereas they assessed differences in sociodemographic factors and oral health literacy (OHL) levels by using a homogeneity χ² test (P < .2 criterion).ResultsThe concordance between caregivers' assessments and clinically determined OHS was lower for younger children (< 2 years, ρ = 0.29 versus = 2 years, ρ = 0.63 [homogeneity P = .03]), a pattern that was evident in the community clinic but not in the university clinic. Caregivers' age, education and OHL did not influence the accuracy of self-reports.ConclusionsFor children younger than 2 years, caregivers' assessments correlated poorly with clinical needs, which routinely were underestimated.Practice ImplicationsThese findings underscore the importance of preventive dental visits at a young age and the early establishment of a dental home.     

Maternal self-report of oral health in 4-year-old Pacific children from South Auckland, New Zealand: findings from the Pacific Islands Families Study

OBJECTIVES: To report on the oral health risk in a disadvantaged group of 4-year-old Pacific children and their mothers living in South Auckland, New Zealand. METHODS: The Pacific Islands Families study follows a cohort of Pacific infants born in 2000. Maternal self-report of mother and child's oral health practices and child's filling and extraction experience was undertaken at interview approximately 4 years postpartum. RESULTS: Overall, 1,048 mothers of children were interviewed. Children's reported oral health practices were generally poor, with 47 percent brushing < or =1/day, 47 percent having no adult assistance with brushing, 57 percent routinely snacking or drinking immediately prior to bed, and 26 percent yet to receive their first dental checkup. Maternal practices were also poor, with 34 percent brushing < or =1/day and 50 percent having never seen or last visiting a dentist over 5 years ago. Significant differences were seen in many practices between the major ethnic subgroups. Of children attending the school dental service, 22 percent were reported having at least one filling and/or extraction. In multivariable analyses, variables corresponding to mother's toothbrushing frequency, child snacking or drinking prior to bed, and duration of breastfeeding were significantly associated with reported filling and/or extraction experience; but no difference was seen between the three major maternal ethnic subgroups. CONCLUSIONS: Many mothers and their Pacific children have poor basic oral hygiene and dietary practices that increase the oral health risk in these children. Culturally appropriate and targeted strategies aimed at these modifiable practices need to be widely promoted so that the oral health burden carried by Pacific children can be reduced.     

Oral health inequalities between young Aboriginal and non‐Aboriginal children living in Ontario,Canada

Abstract – Objectives: To investigate (i) oral health inequalities between off‐reserve Aboriginal and non‐Aboriginal children entering junior kindergarten (JK) in the Thunder Bay District, Northwest Ontario, Canada, (ii) oral health inequalities between kindergarten‐aged (4 years old) Aboriginal children living on reserves in the Sioux Lookout Zone (SLZ), Northwest Ontario and those living off‐reserve in the Thunder Bay District and (iii) early childhood caries (ECC) trends among SLZ children between 2001 and 2005. Methods: Cross‐sectional oral health data (dmft/s Indices) for 416 (2003/2004), 687 (2004/2005) and 544 (2005/2006) 3‐ to 5‐year olds attending JK in the Thunder Bay District were collected by calibrated dental hygienists with the District’s Health Unit. Secondary analysis of oral health status data from two studies conducted in the SLZ between 2001 and 2005 provided the dmft of random samples of children younger than 6 years of age living in 16–20 First Nations communities. Results: When compared with non‐Aboriginal children aged 3–5 years attending the same schools in the Thunder Bay District between 2003 and 2006, off‐reserve Aboriginal children had 1.9 to 2.3 times the risk of having ECC (dmft > 0), 2.9 to 3.5 times the risk of a dmft > 3 and 1.8 to 2.5 times the risk of untreated decayed teeth after adjusting the prevalence ratios for child’s age and sex, school’s risk level and clustered‐correlated data. The mean dmft of on‐reserve Aboriginal 4‐year olds in 2005 was 11.2 and 5.9 for their off‐reserve Aboriginal counterparts. In 2001, the mean dmft scores (95% confidence interval) of 2‐, 3‐ and 4‐year‐old Aboriginal children in the SLZ were: 9.1 (8.3–9.9), 12.4 (11.8–13.1), 13.1 (12.1–14.2). In 2005, similarly aged SLZ children had a mean dmft of: 6.2 (5.2–7.1), 8.9 (8.2–9.6), 11.2 (10.5–11.9), representing significant reductions in caries severity (32%, 28% and 14.5%, respectively). Conclusions: Significant disparities in caries experience exist between off‐reserve Aboriginal and non‐Aboriginal children living in the same locales and between Aboriginal children living on‐ and off‐reserve in northwestern Ontario. The study showed decreased trends in the severity of ECC for children in the SLZ occurring over the 5‐year period. Despite this progress, the oral health of young Aboriginal children in Ontario continues to lag far behind that of non‐Aboriginal children, demanding further programs and policies to tackle the social determinants of oral health and resolve these inequalities.     

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.     

A longitudinal study of oral health in immigrant children in Sweden

Children immigrating into Sweden from Finland and Southern Europe (Greece, Yugoslavia and Turkey) were subjected to a longitudinal study on caries activity and gingival condition. For each immigrant child a Swedish "twin" of the same sex and age was used as a control. Out of 124 pairs originally examined, 75 were reexamined after a 2 1/2-year stay in Sweden. The study showed that on arrival in Sweden the Finnish children had more caries and a higher Gingival Index (GI) than the controls and that they acquired more carious lesions during their stay in this country. Their GI, however, did not develop less favorably than that of the Swedish controls. The South-European children did not seem to have more carious lesions than the Swedish controls on arriving, nor did they seem to acquire more carious lesions during the period of observation. Their GI was higher at the first examination but the change in this index ran parallel with that of the controls. It was concluded that the children immigrating from Finland should be considered a risk group with regard to oral health.     

Prevalence of Early Childhood Caries Among Very Young Urban Boston Children Compared with US Children

Objectives: The aims of this study were to compare prevalence of early childhood caries (ECC) in 1- to 3-year-old children seeing primary-care pediatricians at two urban medical centers in Boston to the prevalence of ECC in similarly aged US children surveyed as part of the Third National Health and Nutrition Examination Survey (NHANES III) and to assess risk factors for ECC among this cohort of children compared with risk factors among similarly aged US children. Methods: Characteristics of 787 1- to 3-year-old children from two urban Boston medical centers were compared with those of 3,644 similarly aged US children surveyed as part of NHANES III. Demographic and social characteristics and ECC prevalence by putative risk factors were compared. A multiple logistic regression model was fit to assess putative risk factors and difference between groups simultaneously. Results: Race, age, previous dental visit, parents' education, and household income were significantly associated with ECC prevalence. Parents' place of birth was a significant effect modifier with lower ECC among Boston children of immigrants than among US children of immigrants. Conclusions: Lower ECC prevalence among urban Boston children of immigrant parents compared with US children of immigrant parents may reflect changing immigrant composition in the United States since NHANES III or a different immigrant composition in the Boston area compared with the United States. This finding reinforces the need for further research of immigrants in order to understand cultural practices that may affect oral health. Finally, low ECC prevalence among very young children reinforces the importance of early intervention in reducing ECC.     

婴幼儿龋病相关因素的初步研究

目的 :了解我国婴幼儿龋病发病的相关因素。方法 :对沈阳市 1860名 8～ 3 6个月的儿童进行患龋情况检查。随机抽取婴幼儿龋组和无龋组各 12 0对母子进行问卷调查及口腔卫生检查。结果 :母亲的文化水平、DMFT及菌斑产酸能力对婴幼儿龋病有影响 (P <0 .0 1) ;婴幼儿期喂养方式与婴幼儿龋病无明显关系 (P >0 .0 5 ) ;断奶时间、含奶瓶或乳头睡觉习惯、甜食习惯与婴幼儿龋病的发生有关系 (P <0 .0 5 ) ;婴幼儿口腔卫生与婴幼儿龋病的发生有关系 (P <0 .0 0 1)。结论 :为了预防婴幼儿龋病应提高母亲素质、宣传正确的饮食方式及注意婴幼儿口腔卫生。     

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.     

Eating disorders and oral health: a matched case-control study

The aim was to compare the oral health status of patients with eating disorders (EDs), with sex- and age-matched controls, with a view to identify self-reported and clinical parameters that might alert the dental healthcare professional to the possibility of EDs. All patients who entered outpatient treatment in an ED clinic during a 12-month period were invited to participate. Of 65 ED patients who started psychiatric/medical treatment, 54 agreed to participate. Eating disorder patients and controls answered a questionnaire and underwent dental clinical examinations. Multivariate analysis identified significantly higher ORs for ED patients to present dental problems (OR = 4.1), burning tongue (OR = 14.2), dry/cracked lips (OR = 9.6), dental erosion (OR = 8.5), and less gingival bleeding (OR = 1.1) compared with healthy controls. Sensitivity and specificity for the correct classification of ED patients and controls using the five variables was 83% and 79%, respectively. The ED patients with vomiting/binge eating behaviors reported worse perceived oral health (OR = 6.0) and had more dental erosion (OR = 5.5) than those without such behavior. In ED patients with longer duration of the disease, dental erosion was significantly more common. In conclusion, oral health problems frequently affect ED patients, and this needs to be considered in patient assessment and treatment decisions.     

The Necessity of qualitative research for advancing oral health

Researchers are engaged with producing knowledge. Through this knowledge production, they make claims about the world. For applied health researchers, our knowledge production is both a scientific as well as a moral activity. Increasingly, oral health researchers are turning to qualitative research, a research approach that takes science and morality seriously. Qualitative research pushes researchers to think about the different worlds in which people live and work, and endeavours to generate data that reflect those worlds. This paper argues that humans are complex, and that qualitative approaches are necessary for understanding how we are all deeply embedded in historical, social, cultural and political contexts, and why this matters when thinking about oral health. This paper also dispels myths about the limitations of qualitative research and proposes future directions to improve the sophistication of qualitative oral health sciences.     

Oral health of young children in Mississippi Delta child care centers: a second look at early childhood caries risk assessment

Objectives: To identify the predictors of early childhood caries and urgent dental treatment need among primarily African‐American children in child care centers in the Delta region of Mississippi. The purpose of this study was to replicate predictors of caries and urgent dental treatment needs that were identified in an earlier study conducted in Delta child care centers and to assess additional caries risk factors not collected in the original study. Methods: Children in 19 child care centers were examined by the dentists, and the parents provided data on oral health practices, oral health history, and on children's oral health‐related quality of life (QOL). The dentists also assessed visible plaque and tested levels of mutans streptococci. Predictors of caries and treatment need among children 24 to 71 months of age were examined using logistic regression. Results: Two parent predictors of caries identified in the earlier study (parent flossing and soft/sugary drink consumption) were not predictive in the current study. Parent history of abscess continued to predict their child's urgent need for treatment. Young children's level of salivary mutans streptococci, maxillary incisor visible plaque, and parents' reports of child oral health‐related QOL measures predicted the presence of both caries and urgent treatment need. Some expected predictors, such as frequency of child's toothbrushing, were not predictive of caries. Conclusions: Parental abscess and parent's report of the child's oral health‐related QOL are risk indicators for poor oral health outcomes that could be used by nondental personnel to identify young children in need of early preventive intervention and dental referral.     

Intellectual disability and impact on oral health: a paired study

The objective was to assess the oral health status, the treatment needed, and the type of dental health services access of intellectually disabled (ID) subjects in Teresina, Brazil. The sample consisted of 103 ID subjects matriculated in centers for special needs people and 103 siblings. Results were analyzed using paired t‐test, chi‐square test, and odds ratio. ID subjects had fair (63.1%; p < .001) and their siblings had a good oral hygiene (n = 103 [55.3%]; p < .005). ID had more decayed (3.52; p < .005), and missing teeth (1.17; p = .001), fewer dental restorations (1.67; p = .012) and had a greater need for tooth extraction (21.4%; p = .002) than their siblings. Thirty percent of ID subjects had never received dental treatment and had difficulty accessing public health services. Their treatment needs were, therefore, higher than non‐ID subjects. The access to oral health services was unsatisfactory, thus it is important to implement educational and health promotion inclusion policies for people with ID.     

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.