Implementing an oral health policy in long-term care facilities for older adults in Flanders, Belgium: The Oral Health Care Track.

BACKGROUND: The oral health of care-dependent older people living in residential care facilities is generally suboptimal. To facilitate adequate daily oral care and timely referral to a dental professional, studies emphasise the need for sustainable, structured oral healthcare policies in aged care organisations. The effect of such interventions is often limited or uncertain owing to a lack of understanding of how effective the integration and implementation of the policy has been within the facilities. This study reports on the development of a method to adequately implement an oral healthcare policy in long-term care organisations for older adults. MATERIALS AND METHODS: An intervention mapping protocol was used to develop a theory- and practise-based methodology. This step-by-step approach combined findings from a literature review, experiences from earlier projects and behaviour change theories in a multilevel programme. RESULTS: Intervention mapping yielded a systematic programme for implementing an oral healthcare policy in aged care organisations. The Oral Health Care Track or "De Mondzorglijn" comprises seven phases, each subdivided into several tasks. The programme's implementation is guided by oral healthcare coaches. CONCLUSION: By using intervention mapping, it was possible to combine behaviour change theories, information derived from needs assessment and earlier experiences into a comprehensive programme to improve the oral health and quality of life of older residents in residential care facilities. Further research is needed to evaluate the use of coaches in the implementation of the Oral Health Care Track.

Is use of CBCT without proper training justified in paediatric dental traumatology? An exploratory study.

BACKGROUND: Proper skills in radiographic diagnosis are essential for optimal management of dental trauma. AIM: To assess diagnostic accuracy obtained by paediatric dentists using Cone Beam Computed Tomography (CBCT) without specific training and to compare this with their performance using intraoral radiographs. METHODS: Intraoral and CBCT images of 89 teeth, spread over twenty dental trauma cases were presented in random order to nine paediatric dentists. Diagnostic findings were compared with those of a benchmark reference. Sensitivity and specificity were calculated and compared using paired t-tests. RESULTS: Overall, observers' diagnostic performance was rather poor with significantly higher sensitivity when using 2D images (P = 0.017). Performance differed considerably according to the type of pathology. Using either imaging modality, sensitivity for diagnosing apical pathology and root fractures was high while the opposite was seen for inflammatory root resorption, root cracks and subluxations. Statistically significant differences between imaging modalities were seen for root fractures (P = 0.013) and apical pathology (P = 0.001), in favor of 3D, and for crown fractures (P = 0.009) in favor of 2D. CONCLUSION: Overall poor performance of paediatric dentists indicates that additional training in radiographic diagnosis is required. In order to justify the use of CBCT to increase diagnostic performance, proper training of the paediatric dentist is mandatory.

Determination of craniofacial and dental characteristics of individuals with Williams-Beuren syndrome by using 3D facial scans and radiographs.

BACKGROUND: Williams-Beuren syndrome (WBS) is caused by a microdeletion on chromosome 7q11-23 and clusters a variety of systemic affectations. AIM: To investigate whether 3D facial scans can detect WBS by objectively addressing their craniofacial, skeletal and dental characteristics, compared with those of a non-affected control group. MATERIALS AND METHODS: 3D facial surface scans of 17 WBS individuals and 33 normal developing patients were analysed. Additionally, cephalometric and panoramic radiographs of subjects with WBS were compared with those of non-affected individuals. RESULTS: The 3D surface scans showed significant facial differences around the nose and mouth area. The cephalometric aspects of individuals with WBS differed mainly at the lower incisor region. Additionally, hypoplastic tooth morphology seems to be more often present in WBS. CONCLUSION: 3D images are a non-invasive, efficient method to observe facial anomalies and facilitate an early diagnosis of WBS. Additionally, the analysis of the cephalometric and panoramic images revealed significant differences in dental characteristics. Together with early diagnosis through 3D images, these can help in the establishment of adequate medical, dental and orthodontic treatment planning.

Evolution of root length throughout orthodontic treatment in maxillary incisors with previous history of dental trauma: a longitudinal controlled trial.

OBJECTIVES: To compare changes in root length of maxillary incisors with and without dental trauma throughout orthodontic treatment. MATERIALS AND METHOD: Patients younger than 18 years, with trauma on at least one maxillary incisor, undergoing orthodontic treatment between 2017 and 2021 were included, using the contralateral side as control without trauma when available. Periapical radiographs were taken pre-treatment and at 6 months intervals, and root/crown ratio was calculated. Linear mixed models were used to describe the evolution of root length at the different time points and to compare trauma and control values. Differences between central and lateral incisors and between treatment modalities were additionally explored. RESULTS: A total of 1768 measurements were performed on 499 teeth (201 with trauma) in 135 patients. Incisor root length significantly decreased during orthodontic treatment in teeth with and without trauma. Lateral incisors with trauma were more susceptible to root resorption than those without trauma and central incisors. No significant decrease in root length was observed with removable appliances, which never exceeded 15 months of treatment. Treatment with fixed appliances led to gradually increasing, significant root length shortening in teeth with and without trauma. CONCLUSION: Treatment duration directly correlated with root length shortening both in teeth with and without trauma history. Teeth with trauma showed significantly more root resorption after treatment with fixed appliances while removable appliances had no significant influence on root length. CLINICAL RELEVANCE: Previous history of dental trauma is no absolute contra-indication to start orthodontic treatment, as long as treatment duration is kept as short as possible.

Impact of case complexity on paediatric dentists' ability to radiographically diagnose traumatic dental injuries.

BACKGROUND/AIMS: Being able to correctly interpret radiographs after a traumatic dental injury is an essential skill for providing appropriate and timely treatment. The aim of this study was to assess the impact of case complexity on paediatric dentists' performance when radiographically diagnosing traumatic dental injuries (TDI) and to investigate a possible added value of cone-beam computed tomography (CBCT) when compared with digital intra-oral radiography (2D vs 3D). MATERIALS AND METHODS: A test panel of paediatric dentists was instructed to detect, identify and interpret radiographic findings using either 2D or 3D images. Intra-oral radiographs and CBCT images of 20 trauma cases were presented in random order, and the findings were recorded using structured scoring sheets. Case complexity was determined by two experienced benchmark scorers. Results were analysed using generalized linear mixed modelling. RESULTS: In general, performance for detection, identification and interpretation of findings was low, both with 2D and 3D images, with significantly lower values for difficult cases (p < 0.05). For easy as well as for difficult cases, 3D imaging resulted in a significantly better performance for detection and identification of findings (P < 0.001). This was not the case for correct interpretation, where significantly poorer performance was seen when using 3D images for difficult cases (p < 0.05). CONCLUSION: This study provides evidence that case complexity of traumatic dental injuries influences diagnostic performance. The use of CBCT enhanced detection and identification of findings but when case complexity increased, 3D imaging adversely affected correct interpretation.

Does clinical experience with dental traumatology impact 2D and 3D radiodiagnostic performance in paediatric dentists? An exploratory study.

BACKGROUND: The aim of this study is to evaluate the impact of experience with traumatic dental injuries (TDI) on paediatric dentists' performance and self-assessed confidence when radiodiagnosing traumatic dental injuries (TDI) and to explore whether this is influenced by the imaging technique used (2D versus 3D). MATERIALS AND METHODS: Both 2D and 3D radiological images of young anterior permanent teeth having experienced dental trauma were assessed randomly by a panel of paediatric dentists using structured scoring sheets. The impact of level of experience with dental traumatology on radiological detection, identification and interpretation of lesions and on observer's self-assessed confidence was evaluated. Findings were compared to benchmark data deriving from expert consensus of an experienced paediatric endodontologist and dentomaxillofacial radiologist. Results were analysed using generalized linear mixed modelling. RESULTS: Overall, observers performed moderately to poor, irrespective of their level of TDI experience and imaging modality used. No proof could be yielded that paediatric dentists with high TDI experience performed better than those with low experience, for any of the outcomes and irrespective of the imaging modality used. When comparing the use of 3D images with 2D images, significantly higher sensitivities for the detection and correct identification of anomalies were observed in the low experienced group (P < 0.05). This was not the case regarding interpretation of the findings. Self-assessed confidence was significantly higher in more experienced dentists, both when using 2D and 3D images (P < 0.05). CONCLUSION: There was no proof that paediatric dentist's higher experience with TDI is associated with better radiodiagnostic performance. Neither could it be proven that the use of Cone Beam Computed Tomography (CBCT) contributes to an improved interpretation of findings, for any experience level. More experienced dentists feel more confident, irrespective of the imaging modality used, but this does not correlate with improved performance. The overall poor performance in image interpretation highlights the importance of teaching and training in both dental radiology and dental traumatology.

Antibiotics at replantation of avulsed permanent teeth? A systematic review.

OBJECTIVES: At present there is no clear consensus whether systemic antibiotics should be administered at replantation of an avulsed permanent tooth. This systematic review and meta-analysis assessed the evidence on effectiveness and harms of the administration of systemic antibiotics at replantation of avulsed permanent teeth. METHODS: In August 2020 a systematic literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, for systematic reviews, randomized controlled trials (RCT) and observational controlled studies in MEDLINE, PreMedline, Embase, and the Cochrane databases. The population of interest were medically fit patients with a replanted avulsed tooth. Main outcomes were tooth survival, periodontal healing, pulpal revascularization as well as (severe) adverse events. These outcomes were compared in patients who did and who did not receive systemic antibiotics. The GRADE methodology was used to assess the quality of evidence. RESULTS: The search yielded no RCTs, and none of the 7 included observational studies had the prime intent to investigate the effectiveness or harms of antibiotics. According to GRADE, the overall level of evidence was very low. The meta-analyses showed non-significant associations between the administration of systemic antibiotics on the one hand and tooth survival (1 study, RR = 3.70, 95% CI: 0.63-21.69), periodontal healing (meta-analysis of 6 studies RR: 1.07; 95% CI: 0.80-1.45), and pulpal revascularization (meta-analysis of 2 studies, RR: 0.36; 95% CI: 0.05-2.41) on the other hand. CONCLUSION: Currently there is no high-quality evidence to support the use of systemic antibiotics at replantation of avulsed permanent teeth. Hence, their routine use cannot be recommended in medically fit patients. Well-designed RCTs should be a priority on the research agenda.

Are systemic antibiotics indicated in children presenting with an odontogenic abscess in the primary dentition? A systematic review of the literature.

OBJECTIVES: This systematic review aimed to assess (1) whether systemic antibiotics are beneficial or harmful in healthy children who present with an odontogenic abscess in the primary dentition with or without systemic involvement and (2) if antibiotics are beneficial, which type, dosage and duration are the most effective. MATERIALS AND METHODS: Electronic databases (Medline, Embase, and the Cochrane Library) were screened from 1948 up to August 2020. No filters with respect to study design were applied. Outcomes of interest included pain, swelling, pain relief, adverse effects, signs of infection, quality-of-life measurements and medication required for pain relief. RESULTS: Altogether, 352 titles and abstracts were screened for eligibility; of these, 19 were selected for full text assessment. All were excluded because none of them fulfilled the inclusion criteria and addressed the (adjunctive) use of antibiotics in children who present with an odontogenic abscess in the primary dentition. CONCLUSIONS: At present, there is no single randomised or non-randomised clinical study evaluating the effectiveness and harms of systemic antibiotics administered in children who present with an odontogenic abscess in the primary dentition. CLINICAL RELEVANCE: There is no clinical evidence to support nor to refute the use of antibiotics in children who present with an odontogenic abscess in the primary dentition without signs of local spread or systemic involvement. Given this lack of scientific evidence, the use of antibiotics cannot be recommended in these children. Well-designed clinical trials are indicated to fully understand the impact and necessity of antibiotics in these situations.

Assessment of oral health in older adults by non-dental professional caregivers-development and validation of a photograph-supported oral health-related section for the interRAI suite of instruments.

OBJECTIVES: An optimized oral health-related section and a video training were developed and validated for the interRAI suite of instruments. The latter is completed by professional non-dental caregivers and used in more than 40 countries to assess care needs of older adults. METHODS: The optimized oral health-related section (ohr-interRAI) consists of nine items and a video training that were developed in consecutive phases. To evaluate psychometric properties, a study was conducted in 260 long-term care residents. Each resident was assessed by a dentist and by four caregivers (two who received the video training, two who did not). RESULTS: Mean kappa values and percent agreement between caregivers and dentist ranged between κ = 0.60 (80.2%) for dry mouth and κ = 0.13 (54.0%) for oral hygiene. The highest inter-caregiver agreement was found for dry mouth with κ = 0.63 [95% CI: 0.56-0.70] (81.6%), while for the item palate/lips/cheeks only κ = 0.27 [95% CI: 0.18-0.36] (76.7%) was achieved. Intra-caregiver agreement ranged between κ = 0.93 [95% CI: 0.79-1.00] (96.4%) for dry mouth and κ = 0.45 [95% CI: 0.06-0.84] (82.8%) for gums. Logistic regression analysis showed only small differences between caregivers who watched the video training and those who did not. CONCLUSIONS: Psychometric properties of the optimized ohr-interRAI section were improved compared to previous versions. Nevertheless, particularly the items based on inspection of the mouth require further refinement and caregiver training needs to be improved. CLINICAL RELEVANCE: Valid assessment of oral health by professional caregivers is essential due to the impaired accessibility of regular dental care for care-dependent older adults.

The perception of oral health and oral care needs, barriers and current practices as perceived by managers and caregivers in organizations for people with disabilities in Flanders, Belgium.

OBJECTIVES: To assess the perception of oral health and oral care needs, barriers and current practices as perceived by managers and caregivers in organizations for people with disabilities in Flanders. MATERIALS AND METHODS: Two questionnaires were developed, one for managers and one for caregivers. The questionnaires were distributed in all 570 organizations for people with disabilities in Flanders. The survey was carried out in February 2018. RESULTS: Sixty-five managers completed the questionnaire and 63 of them could be linked to 57 unique organizations (10% of the contacted organizations). Managers perceived oral health to be better (P = 0.019) and mentioned less oral health needs (P = 0.049), when collaboration with a dentist was reported. When an oral health policy had been established in their organization, oral health was also perceived to be better (P = 0.048). The responses of 91 caregivers were included for analysis and 87 of them could be linked to 39 unique organizations (7% of contacted organizations). Seventy percent and 75% of the caregivers mentioned to have enough/comprehensive theoretical knowledge and practical skills, respectively, and 46% were interested in receiving oral health education. Most interest was shown in practical education and education customized to clients' needs. In organizations with an oral health project, more caregivers indicated that the organization was open to oral health questions than in organizations without such a project (97% compared with 81%; P = 0.045). When there was a collaboration with a dentist, the organization was more open to caregivers' questions (96% compared with 72%; P = 0.004) and a clear contact point was more readily available (81% compared with 48%; P = 0.004). Furthermore, caregivers were more interested to receive oral health education (P = 0.023) and mentioned to be more aware of the oral health of their clients (P = 0.015). About 23% and 30% of the caregivers indicated that guidelines were used in their organization for cleaning natural teeth and prostheses, respectively. CONCLUSIONS: Despite the low response rate to the survey and reaching the management and caregivers of only 10% and 7% of the organizations respectively, this study indicates relevant issues to be incorporated when formulating recommendations for oral health promotion in people with disabilities in Flanders. CLINICAL RELEVANCE: The results of this survey could affect the development of strategies and interventions to ameliorate the oral health of people with disabilities.

Secondary caries: prevalence, characteristics, and approach.

OBJECTIVES: The objectives of this cross-sectional survey were to determine the prevalence of secondary caries (SC) in general population, to identify patient- and material-related factors which may affect the prevalence, and to describe some clinical characteristics of SC lesions. MATERIALS AND METHODS: A total of 4036 restorations in 450 patients, who visited the university dental clinic for a regular (half) yearly checkup, were examined clinically (and radiographically) for the presence of SC. Clinical characteristics of the detected SC lesions (size, activity, and location) and the planned treatment were recorded. In addition, patients' caries-risk status was assessed according to the modified "cariogram" model. RESULTS: In total, 146 restorations were diagnosed with SC, which gives an overall prevalence of 3.6%. Restorative material, restoration class, patient's caries risk, and smoking habits were shown to be important factors, as SC prevalence was significantly higher with composites, class II restorations, high-caries-risk patients, and smokers. Restorations' gingival margins were most frequently affected by SC. The largest number of restorations with SC (72%) was scheduled for the replacement. CONCLUSIONS: Prevalence of SC was higher with composite than with amalgam restorations, irrespective of the patient's caries-risk status. Gingival margins of class II, including MOD restorations, seem to be the place of less resistance to SC development. Management of SC seems to place a considerable burden on the health care workforce and expenditure. CLINICAL RELEVANCE: Secondary caries (SC) is considered to be the main cause of dental restoration failure and one of the biggest clinical challenges related to dental composites. Nevertheless, its prevalence in daily practice is still not clear, which impedes an accurate estimation of its impact on health care costs.

Orthodontic treatment recommendation and expected adverse reactions in patients with a history of dental trauma: A survey among general dentists, paediatric dentists, and orthodontic specialists.

BACKGROUND: Trauma-induced adverse reactions may trigger complications when moving teeth orthodontically. AIM: The purpose of this study was to evaluate the knowledge of dental practitioners about this topic. DESIGN: A questionnaire survey was organized among general dentists, paediatric dentists, and orthodontists in Flanders (Belgium). Three clinical cases describing trauma-induced tooth damage (tooth ankylosis, apical root resorption, and pulp/root canal obliteration) were presented, followed by a set of questions. RESULTS: The questionnaire was completed by 121 general dentists (GD), 47 paediatric dentists (PD), and 99 orthodontic specialists (OS). In the case with ankylosis, impossibility to move the tooth orthodontically was reported as most frequent adverse reaction (82.8% of GD, 95.7% of PD, and 100.0% of OS) (P < .001). In the situation of apical root resorption, the most frequently reported adverse event was progressive apical root resorption (78.9%, 85.7%, and 88.8% respectively; P = .265). Most frequently mentioned adverse reaction in the case with pulp and root canal obliteration was tooth discoloration (64.1%, 57.1%, and 78.3%; P = .055), followed by apical root resorption (57.4%, 56.8%, and 68.7%; P = .283). Orthodontic treatment recommendation differed among specific clinical situations but also among groups of dental practitioners. CONCLUSIONS: Important knowledge gaps exist regarding the orthodontic managment of traumatized teeth. This topic requires more attention in undergraduate training, specialist training, and continuing education.

Assessment of oral health conditions presented in photographs - is there a difference between dentists and non-dental professional caregivers?

BACKGROUND: Photographs can help non-dental professional caregivers to identify problems when inspecting the mouth of care-dependent older individuals. This study evaluated whether the assessment of oral health-related conditions presented in photographs differed between dentists and non-dental professional caregivers. MATERIALS AND METHODS: One-hundred-and-seventy-nine photographs were taken from long-term care facility residents and from patients at the Department of Dentistry of a University Hospital. The following oral health aspects were depicted: denture hygiene, oral hygiene, teeth, gums, tongue and palate/lips/cheeks. Collection continued until for each oral health aspect a pool of photographs was available that showed conditions from perfect health and hygiene to severe problems. A segmented Visual Analogue Scale was applied to assess the conditions presented in the photographs. Each photograph was assessed by each participant of this study. The benchmark was established by three dentists with academic-clinical expertise in gerodontology, special needs dentistry and periodontology. For each photograph, they provided a collective score after reaching consensus. Photographs were assessed individually by 32 general dentists and by 164 non-dental professional caregivers. Linear mixed effects models and generalized linear mixed effects models were fitted and mean squared errors were computed to quantify differences between both groups. RESULTS: For the different oral health aspects, absolute distances from the benchmark scores were 1.13 (95%CI:1.03-1.23) to 1.51 (95%CI:1.39-1.65) times higher for the caregivers than for the dentists. The odds to overestimate the condition were higher for the caregivers than the dentists for oral hygiene (OR = 0.72, 95%CI = 0.62-0.84) and teeth (OR = 0.74; 95%CI = 0.61-0.88). The odds to underestimate the condition were higher for the caregivers than the dentists for gums (OR = 1.39; 95%CI:1.22-1.59) and palate/lips/cheeks (OR = 1.22; 95%CI = 1.07-1.40). Over all assessments, the variance in caregiver scores was 1.9 (95%CI:1.62-2.23) times higher than that for the dentists. CONCLUSION: Small but significant differences were found between dentists and non-dental professional caregivers assessing oral health-related conditions presented in photographs. When photographs are used to aid non-dental professional caregivers with the oral health assessment, these visualizations should be complemented with comments to facilitate accurate interpretation.

Knowledge of orthodontic treatment approach of traumatized teeth by a group of Belgian general dentists, pediatric dentists, and orthodontists.

BACKGROUND/AIM: Traumatized teeth are more susceptible to complications during orthodontic tooth movement. The aim of this study was to explore current practices among Belgian dental practitioners regarding orthodontic treatment of children with a history of dental trauma. MATERIAL AND METHODS: A questionnaire survey was organized among general dentists, pediatric dentists, and orthodontists in Flanders (Belgium). Questionnaires were distributed at the occasions of annual meetings or symposia. They consisted of questions regarding exposure to dental trauma and orthodontic treatment approach for patients with a dental trauma history. RESULTS: The questionnaire was completed by 121 general dentists, 47 pediatric dentists, and 99 orthodontists. A history of dental trauma influenced referral for orthodontic treatment by general dentists and pediatric dentists moderately (median VAS scores of 5 and 6, respectively, on a scale of 0 (not at all) to 10 (utmost)), indicating uncertainty and doubt. Additional checkups during tooth movement were usually not organized by general dentists in 33.6% and by pediatric dentists in 19.1% of cases (P = 0.006). One-third of the orthodontists (33.3%) experienced tooth loss linked to orthodontic movement of a tooth with dental trauma history in at least one patient. Only a minority of the practitioners knew of the existence of specific guidelines (7.6%, 15.6% and 22.7%, respectively, of general dentists, pediatric dentists, and orthodontists) (P = 0.007). The Dental Trauma Guide was the guideline mentioned most frequently, although this tool does not contain recommendations regarding orthodontic treatment after trauma. CONCLUSION: In the group of Belgian general dental, pediatric and orthodontists surveyed, there was uncertainty regarding the orthodontic management of patients with a history of dental trauma especially among general practitioners. Further educational training is recommended.

The oral health-related section of the interRAI: Evaluation of test content validity by expert rating and assessment of potential reasons for inaccurate assessments based on focus group discussions with caregivers.

OBJECTIVES: To explore the failure of the oral health-related section of the interRAI (ohr-interRAI), this study investigated test content validity (A.) and reasons for inaccurate assessments (B.). BACKGROUND: Poor oral health negatively affects quality of life and is associated with a number of systemic diseases. The interRAI instruments, internationally used for geriatric assessment, should accurately detect oral conditions that require care. Previous research showed that the ohr-interRAI and related precursor versions do not achieve this goal. MATERIALS AND METHODS: (A.) A group of 12 experts rated completeness, relevance, clarity of wording and feasibility of the ohr-interRAI. Content validity indices were calculated per item (threshold 0.78). (B.) Focus group discussions with 23 caregivers were organized. A semi-structured question guide made sure that all topics of interest were covered. Qualitative content structuring analysis was applied after transcription. RESULTS: (A.) Experts agreed on the relevance of the items on chewing, pain, gingival inflammation and damaged teeth. They regarded none of the items as worded clearly and only prosthesis use and pain were considered to be assessable by untrained caregivers. All experts agreed that the ohr-interRAI was incomplete. (B.) Focus group discussions revealed that in the care environment oral health had low priority. Aspects related to the ohr-interRAI itself and aspects related to the assessment situation impeded the oral health assessment. The approach of the caregivers to complete the ohr-interRAI was inappropriate to accurately detect oral care needs. CONCLUSIONS: Findings challenge test content validity of the ohr-interRAI and reveal reasons for inaccurate assessments.

Effect evaluation of an oral health promotion intervention in preschool children.

OBJECTIVE: This study evaluates the effectiveness of a multi-component oral health intervention in preschool children in a non-randomized intervention study with a complementary baseline control. METHODS: Participants in the main study were 2137 children born between October 2003 and July 2004 in Flanders, Belgium. In the intervention group (50.5% of participants), an oral health education program was added to a standard preventive care program during the first 3 years of life. Oral health examinations were performed by trained dentists when the children were 3 (2007) and 5 (2009) years old. Data on dietary habits, oral hygiene habits and dental attendance were obtained through structured questionnaires. Regression analyses were applied to compare the results of the intervention and control group with baseline measurements obtained before the intervention (2003) in other cohorts of 3- (N = 1291) and 5-year-olds (N = 1325) living in the same regions. RESULTS: The prevalence of caries experience was generally lower in the main study compared with the baseline cohorts, with little differences between the intervention and control group. For the oral health-related behaviours, the control group scored mostly better. Nevertheless, compared with baseline, limited differences were observed in dental attendance, tooth brushing, helping with tooth brushing and consuming in-between drinks (P < 0.05). CONCLUSION: The study illustrates that a multi-component, theory-based intervention at community level had only a limited and temporary effect on oral health-related behaviours in the community under study. Further research is needed to determine how oral health in young children can be improved in the long term.

Nursing home residents' perspectives on oral health: An in-depth interview study.

Background: Oral health is associated with general health and care dependency, but is often neglected in nursing homes. Integration of oral care into general care is necessary, but is hampered by multiple barriers at different levels. This study is part of research into the implementation of the new Oral Health Section for use within the interRAI Long-Term Care Facilities instrument, which is used to assess care needs of nursing home residents. This new Oral Health Section evaluates nine aspects of oral health and results in two Collaborative Action Points. Objective: To identify residents' perspectives on oral health, oral care, and on the assessment of their oral health using the new Oral Health Section. Design: Qualitative design using in-depth interviews. Settings: Three nursing homes. Participants: Residents were selected using purposeful sampling in nursing homes participating in research evaluating the use of the new Oral Health Section. The selection was based on their oral status for maximum variation and on their cognitive performance score. Twenty-two residents from three Flemish nursing homes agreed to participate. Methods: Residents' oral health was assessed using the new Oral Health Section and dental indices. In-depth interviews were conducted, including the validated short-form Oral Health Impact Profile to evaluate the impact of oral conditions on residents' well-being. The interviews were coded and analysed by three researchers and mapped into a model to understand participants' oral health behaviours. Results: Low Oral Health Impact Profile scores indicated a low impact of oral health issues on participants' lives. However, despite 77.3 % of the participants reporting satisfaction with their oral health, 86.4 % had poor oral hygiene and 68.2 % required referral to a dentist, suggesting a tendency to overestimate their oral health. Their oral health behaviour was determined by a lack of oral health knowledge (Capability), positive attitudes towards oral health and autonomy (Motivation), upbringing and social support (Opportunity). Participants considered assessments with the new Oral Health Section acceptable. Conclusions: This study shows how older people perceive their oral health and oral healthcare. Understanding their wishes and needs will not only facilitate their involvement in their oral care, but is also likely to enable the improvement of their oral hygiene and the development of effective oral care strategies for the future. Policy makers and managers of care organisations may use these results to foster integration of oral care guidelines into care protocols within nursing homes, including collaboration with dentists and dental hygienists. Tweetable abstract: Oral health assessments with the new Oral Health Section for use within interRAI were positively perceived by nursing home residents.

A multilevel model for spatially correlated binary data in the presence of misclassification: an application in oral health research.

Dental caries is a highly prevalent disease affecting the tooth's hard tissues by acid-forming bacteria. The past and present caries status of a tooth is characterized by a response called caries experience (CE). Several epidemiological studies have explored risk factors for CE. However, the detection of CE is prone to misclassification because some cases are neither clearly carious nor noncarious, and this needs to be incorporated into the epidemiological models for CE data. From a dentist's point of view, it is most appealing to analyze CE on the tooth's surface, implying that the multilevel structure of the data (surface-tooth-mouth) needs to be taken into account. In addition, CE data are spatially referenced, that is, an active lesion on one surface may impact the decay process of the neighboring surfaces, and that might also influence the process of scoring CE. In this paper, we investigate two hypotheses: that is, (i) CE outcomes recorded at surface level are spatially associated; and (ii) the dental examiners exhibit some spatial behavior while scoring CE at surface level, by using a spatially referenced multilevel autologistic model, corrected for misclassification. These hypotheses were tested on the well-known Signal Tandmobiel® study on dental caries, and simulation studies were conducted to assess the effect of misclassification and strength of spatial dependence on the autologistic model parameters. Our results indicate a substantial spatial dependency in the examiners' scoring behavior and also in the prevalence of CE at surface level.