The impact of COVID-19 on individual oral health: a scoping review.

BACKGROUND: Poor oral health due to dental caries is one of the most prevalent non-communicable diseases worldwide. It has a significant impact on individuals across the lifespan and is a leading cause of preventable hospitalizations. The impacts of COVID-19 on oral health at the practice level are well documented, but gaps in understanding the impact on individual oral health remain. This review addresses this gap. METHODS: Using a JBI scoping review process we mapped and summarized the evidence to identify the impact of COVID-19 on individual oral health. Key search terms were developed, and searches were undertaken by an experienced research librarian. RESULTS: The 85 included studies were conducted in 23 countries from 5 regions across the world classified using the United Nations Geoscheme system. The majority (82/85) were quantitative, 2 were reviews and there was one qualitative interview study. Cross-sectional surveys were the most common data collection approach followed by an analysis of clinical data, analysis of internet trends and other online methods. Five key areas were identified including changes to the provision of emergency dental services, provision of routine oral health services, oral hygiene maintenance at home, changes in dietary preferences, alternative models of dental provision and help-seeking and attitudes towards dental care in the future. CONCLUSIONS: This scoping review has demonstrated that the pandemic has impacted on oral health at the individual level. It is important that we are aware of these impacts and ensure that support systems are in place to overcome future periods where access to dental care might be compromised. The provision of preventive care remains a vital first step in ensuring good overall oral health as is paramount during periods where access to dental treatment might be limited.

An epidemiological study of dental caries and associated risk factors among primary school children in the Aileu Municipality, Timor-Leste.

INTRODUCTION: Recent evidence indicates that the oral health for children in Timor-Leste is deteriorating, with 40% of school children experiencing toothache during 2014. Timorese have easy access to sugar, poor food security and lack of water fluoridation, all of which exacerbate the risk of dental caries. A lack of quality epidemiological data is available to confirm anecdotal information of high caries rates in rural and remote Timor-Leste. Such data are required to inform oral health issues and health policy at both the local and national levels. This study investigated the caries status and potential risk factors among primary school children in the rural Aileu municipality of Timor-Leste. The objectives of this study were to determine caries prevalence and experience, the status (active/arrested) of existing caries lesions and associations between dental caries and potential risk factors, among primary school children in the Aileu municipality, Timor-Leste. METHODS: This study analysed secondary data. De-identified data for this analysis were obtained from North Richmond Community Health (NRCH), Melbourne, Australia. North Richmond Community Health (NRCH) has been working with the Friends of Aileu (a government-to-government partnership between an Australian local government area and the municipality of Aileu) to improve the oral health of school children in the municipality of Aileu. NRCH conducts an outreach school-based oral health promotion program, called Kose Nehan, at six primary schools in the Aileu municipality. Caries was diagnosed using the International Caries Detection and Assessment System (ICDAS) and reported using the decayed, missing and filled teeth (DMFT/dmft) index. Examiners were trained and calibrated. A brief interviewer-administered questionnaire was used to capture information on child oral hygiene and diet behaviours. For the analysis, dental caries was defined as 'any caries lesions' (ICDAS caries codes 1-6). Descriptive and inferential analyses were conducted using STATA 14. Multivariable logistic regression analysis predicting the odds of dental caries (yes/no) was used to determine independent associations between the exposures and the outcome. RESULTS: Data were analysed for 685 children. In the primary dentition, the overall prevalence of caries was 64% and the mean dmft score was 2.74 (standard deviation (SD) 3.08). In the permanent dentition, the overall prevalence was 53% and the mean DMFT score was 1.74 (SD 2.46). Overall, approximately 84% of caries lesions were identified as being active. The multivariable regression analysis did not identify independent predictors of caries. CONCLUSION: Dental caries was highly prevalent among this population and urgent action is required to reduce the population burden of this disease. Malnutrition, which was not measured for this study, is highly prevalent among children in Timor-Leste and could explain the high caries rates in this population. The effect of malnutrition on dental caries and vice-versa needs further investigation. Programs and policies are urgently needed for oral health promotion and also the prevention and management of dental caries in Timorese children. These strategies should also address the urgent need for emergency dental services aimed at pain relief, first aid for oral infections and restorations, given the high prevalence of advanced disease in this child population.

Health literacy interventions for informal caregivers: systematic review.

AIM: The aim of the systematic review was to identify conceptual models and interventions designed to improve health literacy in caregivers of adults with a chronic disease/disability. METHODS: MEDLINE, CINAHL, PsycINFO and Embase were searched for relevant literature. Articles were included if they focused on adults who provided informal care to someone aged 18+ with a chronic disease/disability. Quantitative studies were included if they reported an intervention designed to improve caregiver health literacy (CHL) and assessed outcomes using a validated measure of health literacy. Qualitative and mixed method studies were included if they described a conceptual model or framework of CHL or developed/assessed the feasibility of an intervention. Study quality was appraised using the Mixed Methods Assessment Tool. RESULTS: Eleven studies were included. Five studies used pre-post design to assess outcomes of an intervention; four described intervention development and/or pilot testing; two described conceptual models. Two of five studies reported pre-post intervention improvements in CHL; one reported an improvement in one of nine health literacy domains; two reported no improvements following intervention. Interventions predominantly aimed to improve: caregiver understanding of the disease, treatment and potential outcomes, day-to-day care, self-care and health provider engagement. Few interventions targeted broader interpersonal and health service factors identified as influencing CHL. DISCUSSION: Evidence on the development and assessment of comprehensive CHL interventions is scarce. Recommendations include the development of interventions that are guided by a CHL framework to ensure they address individual, interpersonal and health service/provider factors that influence CHL.

Education/Training Interventions to Improve Oral Health of Adults with Intellectual Disability.

People with intellectual disability have poorer oral health outcomes and experience greater difficulties accessing dental services than the rest of the community. Interdisciplinary educational programs for those involved in oral health decision making for people with intellectual disability aim to improve their oral health. This scoping review explored education/training interventions related to the oral health of adults with intellectual disability. Interventions targeted dental health and non-dental health professionals, adults with intellectual disability, and their paid and unpaid supporters. Six electronic databases were searched using PRISMA guidelines and the Crowes critical appraisal tool. The search strategy, plus the application of the inclusion and exclusion criteria, presented in the body of the manuscript, led to the selection of 20 papers for inclusion into this review. The quality of undergraduate tuition relating to disability was reported to be poor, but students and dental health professionals expressed interest in expanding their knowledge in this area. Disability-support workers and primary carers of people with intellectual disability reported improved knowledge and attitude, but the oral health status of the people they supported was not impacted. No research was found that explored the perspectives of non-dental health professionals. Oral health training/education contributes to systemic barriers in general health, wellbeing, and social inclusion of people with intellectual disability. Revision of disability-related programs in general dentistry courses and longitudinal impact research is needed.