Economic Evaluations of Preventive Interventions for Dental Caries and Periodontitis: A Systematic Review.

OBJECTIVES: To critically examine the methods used for full economic evaluations of preventive interventions for dental caries and periodontitis. METHODS: Published literature post-2000 was searched to April 2021. Based on a developed intervention classification framework for dental caries and periodontitis, only universal, selective or indicated interventions were included in this review. The Drummond 10-point checklist was used for quality appraisal. RESULTS: Of 3,007 unique records screened for relevance, 73 studies were reviewed. Most model-based studies (61/73) used cost-effectiveness analysis (49%) or cost-benefit analysis (28%). Trial-based studies (16/73) commonly used cost-effectiveness analysis (59%). Four studies used both economic evaluation methods. Sixty-four papers (88%) were on dental caries, eight papers (11%) focused on periodontitis, and one paper (1%) included both oral diseases; 72% of model-based and 82% of trial-based studies were of good quality. The most frequently investigated dental caries preventive interventions were water fluoridation (universal intervention; cost-saving or cost-effective), fissure sealant and fluoride varnish (selective and indicated interventions; cost-effectiveness outcomes were inconsistent). Supportive periodontal therapy with oral health education (indicated intervention; cost-effective) was the most frequently evaluated preventive intervention for periodontitis. Thirty percent of studies with a time horizon > 1 year did not apply an appropriate discount rate and 26% did not comprehensively discuss other important considerations beyond the technical analysis. CONCLUSIONS: Generic health outcome measures should be incorporated for economic evaluations on preventive interventions for dental caries and periodontitis, and an increased focus to prevent periodontitis using economic evaluation methods is needed to inform resource allocation and policy decision-making.

Oral cavity status of long-term hemodialized patients vs. their socio-economic status.

BACKGROUND: The chronic kidney disease, blood hypertension and diabetes are recognized as civilization diseases that affect more and more people. The probability of encountering a patient suffering from these diseases is increasing. As such, it appears crucial to better understand the specific dental needs of such groups of patients. The aim of the work was to assess the oral hygiene status and the needs of patients suffering from the end-stage chronic kidney disease, arterial hypertension or/and diabetes. MATERIAL AND METHODS: Two hundred and twenty eight patients were included in the research. One hundred and eighty patients were hemodialized in Diaverum dialysis stations and 48 patients were from the Conservative Dentistry with Endodontics Clinic of the Academic Centre of Dentistry in Bytom, Silesian Medical University in Katowice, and from the Dentistry Division of the Arnika Clinic in Zabrze, and were not not diagnosed with any of the diseases mentioned. The research scheme was divided into 3 parts, consisting of an analysis of the general health socio-economic status, a survey and an assessment of oral health. RESULTS: The patients who were not suffering from any of the discussed diseases were more aware of how to properly perform hygienic procedures. Most of the patients from both the control and examined groups were not using any rinsing solutions. A higher percentage of patients in the control group was using dental floss, changing their toothbrush every 3 months and brushing their teeth for ≥2 min. The Aproximal Plaque Index and the Oral Hygiene Index-Simplified values in the control group were significantly lower in comparison to the examined group. CONCLUSIONS: The socio-economic status of hemodialized patients was low, which in most cases was a result of the difficulties in starting a job. Due to the lower standards of life, the neglect of oral hygiene maintenance and its consequences could be observed. Med Pr. 2020;71(3):279-88.

A pragmatic, multi-centered, stepped wedge, cluster randomized controlled trial pilot of the clinical and cost effectiveness of a complex Stroke Oral healthCare intervention pLan Evaluation II (SOCLE II) compared with usual oral healthcare in stroke wards.

BACKGROUND: Patients with stroke-associated pneumonia experience poorer outcomes (increased hospital stays, costs, discharge dependency, and risk of death). High-quality, organized oral healthcare may reduce the incidence of stroke-associated pneumonia and improve oral health and quality of life. AIMS: We piloted a pragmatic, stepped-wedge, cluster randomized controlled trial of clinical and cost effectiveness of enhanced versus usual oral healthcare for people in stroke rehabilitation settings. METHODS: Scottish stroke rehabilitation wards were randomly allocated to stepped time-points for conversion from usual to enhanced oral healthcare. All admissions and nursing staff were eligible for inclusion. We piloted the viability of randomization, intervention, data collection, record linkage procedures, our sample size, screening, and recruitment estimates. The stepped-wedge trial design prevented full blinding of outcome assessors and staff. Predetermined criteria for progression included the validity of enhanced oral healthcare intervention (training, oral healthcare protocol, assessment, equipment), data collection, and stroke-associated pneumonia event rate and relationship between stroke-associated pneumonia and plaque. RESULTS: We screened 1548/2613 (59%) admissions to four wards, recruiting n = 325 patients and n = 112 nurses. We observed marked between-site diversity in admissions, recruitment populations, stroke-associated pneumonia events (0% to 21%), training, and resource use. No adverse events were reported. Oral healthcare documentation was poor. We found no evidence of a difference in stroke-associated pneumonia between enhanced versus usual oral healthcare (P = 0.62, odds ratio = 0.61, confidence interval: 0.08 to 4.42). CONCLUSIONS: Our stepped-wedge cluster randomized control trial accommodated between-site diversity. The stroke-associated pneumonia event rate did not meet our predetermined progression criteria. We did not meet our predefined progression criteria including the SAP event rate and consequently were unable to establish whether there is a relationship between SAP and plaque. A wide confidence interval did not exclude the possibility that enhanced oral healthcare may result in a benefit or detrimental effect. TRIAL REGISTRATION: NCT01954212.

Oral health of high-cost patients and evaluation of oral health measures as predictors for high-cost patients in South Korea: a population-based cohort study.

OBJECTIVE: To examine the oral health conditions and oral health behaviour of high-cost patients and evaluate oral health measures as predictors of future high-cost patients. DESIGN: A retrospective, population-based cohort study using administrative healthcare records. SETTING: The National Health Insurance Service (NHIS) medical check-up database (a.k.a. NHIS-national health screening cohort database) in South Korea. PARTICIPANTS: 131 549 individuals who received biennial health check-ups including dental check-ups in 2011 or 2012, aged 49-88. PRIMARY OUTCOME MEASURES: Current and subsequent year high-cost patient status. RESULTS: High-cost patients, on average, incur higher dental costs, suffer more from periodontal disease, brush their teeth less and use secondary oral hygiene products less. Some of the self-reported oral health behaviours and oral symptom variables show statistically significant associations with subsequent year high-cost patient indicators, even after adjusting for demographic, socioeconomic, medical conditions, and prior healthcare cost and utilisation. CONCLUSIONS: We demonstrate that oral health measures are associated with an increased risk of becoming a high-cost patient.

[Cost-Effective, Easy-to-Implement, but Still-Neglected Oral Hygiene].

In rapidly aging societies, it is commonly found that the limited number of remaining teeth in elders results in chewing difficulties that cause health problems and malnutrition. Surprisingly, even the latest high-tech oral medical care achieves health maintenance results that are inferior to those regularly achieved by healthy natural teeth. Oral health issues are particularly serious in rural areas. The literature supports a close association between oral hygiene and general health. Because oral microorganisms are known to cause infections and inflammation reactions, people with poor oral hygiene often have high incidences of periodontal disease and tooth loss and an even higher prevalence of cardiometabolic-related chronic diseases, poorer life quality, and higher mortality than their peers with better oral hygiene (Ma et al., 2017; Tsai et al., 2015; World Health Organization, 2018). Although promoting oral hygiene may be done on a minimal budget and with high efficacy, many people retain improper oral-hygiene concepts and behaviors. For instance, many do not recognize the relationship between real teeth and general health, brush their teeth for inadequate durations, and/or apply improper methods. Furthermore, many do not make use of the regular dental cleaning resources available through the National Health Insurance program, leading to poor oral hygiene care outcomes such as tooth decay in school-age children, periodontal disease and tooth loss in adulthood, and the current average of fewer than 20 real teeth in adults 65~80 years of age. All of these poor oral-hygiene realities lead to Taiwan falling far short of WHO oral-health-related goals. Based on the perspective of prevention and health promotion, this column presents the important role of the nursing profession in improving the quality of oral hygiene care through the three critical phases of life: school age, active adulthood, and elderly adulthood. We look to advance national oral hygiene in Taiwan to a standard exceeding that of the World Health Organization in order to demonstrate the practical benefit of Taiwan's two-decade-long National Health Insurance system.

Economic evaluation of an expanded caries-preventive program targeting toddlers in high-risk areas in Sweden.

OBJECTIVE: To economically evaluate a caries-preventive program "Stop Caries Stockholm" (SCS) where a standard program is supplemented with biannual applications of fluoride varnish in toddlers and compared it with the standard preventive program. MATERIAL AND METHODS: Data from the cluster randomized controlled field trial SCS including 3403 children, conducted in multicultural areas with low socioeconomic status was used. The difference in mean caries increment between the examinations; when the toddlers were 1 and 3 years old, was outcome measure of the intervention. The program was evaluated from a societal as well as a dental health care perspective. The incremental cost-effectiveness ratio (ICER) was calculated as the incremental cost for each defs prevented. RESULTS: Average dental health care costs per child at age 3 years were EUR 95.77 for the supplemental intervention and EUR 70.52 for the standard intervention. The ICER was EUR 280.56 from a dental health care perspective and EUR 468.67 and considered high. CONCLUSIONS: The supplemental caries intervention program was not found to be cost-effective. The program raised costs without significantly reducing caries development. A better alternative use of the resources is recommended. TRIAL REGISTRATION: www.controlled-trials.com (ISRCTN35086887).

Reducing missed oral care opportunities to prevent non-ventilator associated hospital acquired pneumonia at the Department of Veterans Affairs.

Consistently delivered, effective oral care targets bacterial multiplication reducing the risk of non-ventilator associated hospital acquired pneumonia (NV-HAP). AIM: Determine the effect of a twice daily oral care initiative on the incidence and cost of NV-HAP. METHODS: This single arm intervention study used pre/post population data to determine the effectiveness of a universal, standardized oral care protocol vs. usual care in preventing NV-HAP. This phase followed a retrospective study of 14,396 patient days (2002-2012) that determined the pre-intervention levels of nursing care provided, and the overall disease prevalence. RESULTS: The pilot incidence rate on the geriatric units decreased from 105 to 8.3 cases per 1,000 patient days (by 92%) in the first year. The intervention yielded an estimated cost avoidance of $2.84 million and 13 lives saved in 19 months post-implementation. Expansion of this study as quality improvement is in progress at 8 VA hospitals with plans for national VA deployment. CONCLUSIONS: While oral care may seem deceptively simple in terms of base care provision, hospital and nursing services struggle to provide effective oral care delivery with high-reliability. Barriers to oral care include: (1) the perception that oral care is an optional daily care activity for patient's comfort, (2) hospitals supply inadequate, poorly designed oral care materials, and (3) hospitals are not required to monitor the incidence of NV-HAP. The impact of consistently delivered oral care is substantial in terms of Veteran health, quality of life, and well-being in addition to considerable cost avoidance.

Assistive technologies for improving the oral hygiene of leprosy patients residing in a former leprosy colony in Betim, Minas Gerais, Brazil.

BACKGROUND: This study deals with management of a group of elderly patients with a history of leprosy and hand deformities by a multidisciplinary team of dentists and occupational therapists. Assistive technology devices have been developed to allow such patients to obtain independence in oral self-care and can be a cost-effective approach to improving oral care in this population. The objective of this study was to describe the development of assistive devices to facilitate daily oral hygiene in older people with enduring leprosy-related impairments. METHODOLOGY: Case study realized among elders with a history of leprosy residents in a former isolation colony in Betim, Minas Gerais, Brazil. The elders were evaluated for dependence on others for denture hygiene and mouthwash using the Daily Oral Hygiene Activity Index (ADOH). Those deemed partially or completely dependent on others were eligible for an intervention based on assistive technology. We adopted a personalized approach to each case, taking into account medical history, physical impairment and living environment. Six months after the intervention, the participants were assessed again using the ADOH and an unstructured interview about use of the devices. PRINCIPAL FINDINGS: Assistive devices for denture hygiene and mouthwash were developed for 16 elders. These devices facilitated oral hygiene in most patients and there was no worsening in any of the cases. Patients' report suggested they were satisfied with the devices provided. CONCLUSIONS: This study demonstrated that assistive devices can facilitate oral hygiene activities in leprosy patients. It also reinforces the importance of using a multidisciplinary team for the rehabilitation of these patients.

Improving the Quality of Dentistry (IQuaD): a cluster factorial randomised controlled trial comparing the effectiveness and cost-benefit of oral hygiene advice and/or periodontal instrumentation with routine care for the prevention and management of periodontal disease in dentate adults attending dental primary care.

BACKGROUND: Periodontal disease is preventable but remains the most common oral disease worldwide, with major health and economic implications. Stakeholders lack reliable evidence of the relative clinical effectiveness and cost-effectiveness of different types of oral hygiene advice (OHA) and the optimal frequency of periodontal instrumentation (PI). OBJECTIVES: To test clinical effectiveness and assess the economic value of the following strategies: personalised OHA versus routine OHA, 12-monthly PI (scale and polish) compared with 6-monthly PI, and no PI compared with 6-monthly PI. DESIGN: Multicentre, pragmatic split-plot, randomised open trial with a cluster factorial design and blinded outcome evaluation with 3 years' follow-up and a within-trial cost-benefit analysis. NHS and participant costs were combined with benefits [willingness to pay (WTP)] estimated from a discrete choice experiment (DCE). SETTING: UK dental practices. PARTICIPANTS: Adult dentate NHS patients, regular attenders, with Basic Periodontal Examination (BPE) scores of 0, 1, 2 or 3. INTERVENTION: Practices were randomised to provide routine or personalised OHA. Within each practice, participants were randomised to the following groups: no PI, 12-monthly PI or 6-monthly PI (current practice). MAIN OUTCOME MEASURES: Clinical - gingival inflammation/bleeding on probing at the gingival margin (3 years). Patient - oral hygiene self-efficacy (3 years). Economic - net benefits (mean WTP minus mean costs). RESULTS: A total of 63 dental practices and 1877 participants were recruited. The mean number of teeth and percentage of bleeding sites was 24 and 33%, respectively. Two-thirds of participants had BPE scores of ≤ 2. Under intention-to-treat analysis, there was no evidence of a difference in gingival inflammation/bleeding between the 6-monthly PI group and the no-PI group [difference 0.87%, 95% confidence interval (CI) -1.6% to 3.3%; p = 0.481] or between the 6-monthly PI group and the 12-monthly PI group (difference 0.11%, 95% CI -2.3% to 2.5%; p = 0.929). There was also no evidence of a difference between personalised and routine OHA (difference -2.5%, 95% CI -8.3% to 3.3%; p = 0.393). There was no evidence of a difference in self-efficacy between the 6-monthly PI group and the no-PI group (difference -0.028, 95% CI -0.119 to 0.063; p = 0.543) and no evidence of a clinically important difference between the 6-monthly PI group and the 12-monthly PI group (difference -0.097, 95% CI -0.188 to -0.006; p = 0.037). Compared with standard care, no PI with personalised OHA had the greatest cost savings: NHS perspective -£15 (95% CI -£34 to £4) and participant perspective -£64 (95% CI -£112 to -£16). The DCE shows that the general population value these services greatly. Personalised OHA with 6-monthly PI had the greatest incremental net benefit [£48 (95% CI £22 to £74)]. Sensitivity analyses did not change conclusions. LIMITATIONS: Being a pragmatic trial, we did not deny PIs to the no-PI group; there was clear separation in the mean number of PIs between groups. CONCLUSIONS: There was no additional benefit from scheduling 6-monthly or 12-monthly PIs over not providing this treatment unless desired or recommended, and no difference between OHA delivery for gingival inflammation/bleeding and patient-centred outcomes. However, participants valued, and were willing to pay for, both interventions, with greater financial value placed on PI than on OHA. FUTURE WORK: Assess the clinical effectiveness and cost-effectiveness of providing multifaceted periodontal care packages in primary dental care for those with periodontitis. TRIAL REGISTRATION: Current Controlled Trials ISRCTN56465715. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 38. See the NIHR Journals Library website for further project information.

[Clinical and economic aspects of professional oral hygiene].

OBJECTIVE: Introduction: Health care is important in all age groups. Good hygienic care is a vital aspect of it. The examination of the dental status in different groups of the adult population records low hygienic indicators, including those of young age. Against this backdrop, there is an urgent need to increase the role of professional hygiene of the oral cavity. The aim: The aim of the study. Identify the clinical and economic aspects of occupational hygiene in young people between the ages of 22 and 35. PATIENTS AND METHODS: Materials and methods: 125 people were surveyed to enhance the motivation of young people to conduct occupational hygiene. Patients are divided into 5 main groups. Among them are men and women, with an intact periodontal disease and with the presence of chronic gingivitis. Evaluated oral hygiene and periodontal status using indices. RESULTS: Results: On the background of insufficient personal hygiene of the oral cavity in young people, effective professional hygiene with a frequency of at least twice a year in people with intact periodontium and three times a year with gingivitis. The economic efficiency of professional hygiene against the background of intact periodontium during the year reaches 42.2%, against the background of gingivitis with twice the occupational hygiene - 46.4%, and three times - 57.8%. CONCLUSION: Conclusions: Periodic professional hygiene during the year provides twice the economic effectiveness of the prevention and treatment of gingivitis in comparison with the corresponding costs in its absence.

Impact of oral hygiene and socio-demographic factors on dental caries in a suburban population in Nigeria.

AIM: This was to determine dental caries determinants in the study participants. METHODOLOGY: This was a secondary data study extracted from primary data through a school-based study that recruited students from primary and secondary schools in a suburban population in Nigeria. The variables included age, gender, socio-economic status, oral hygiene status, type of parenting, birth rank, family size and presence of dental caries. The diagnosis of dental caries was based on the World Health Oral Health Survey recommendations while oral hygiene was determined using simplified-oral hygiene index (OHI-S). Data was analysed using STATA version 13, statistical significance was set at P < 0.05. RESULTS: The prevalence of dental caries for the study population was 12.2%, DMFT and dmft were 0.16 and 0.06 respectively. Children within age groups 11-13 and 14-16 years had reduced chances of having dental caries (P = 0.01; P = 0.01); children with fair oral hygiene and poor oral hygiene had increased odds of having dental caries (P ≤ 0.001; P ≤ 0.001), last child of the family also had increased odds of having dental caries while children from large family size had reduced odds of having dental caries. This study also showed that first permanent molars and second primary molars were mostly affected by dental caries but there was no significant difference between distribution of the maxillary or mandibular jaw or between right and left quadrants. CONCLUSION: Age, oral hygiene, birth rank and family size were the significant determinants of dental caries in the study population and the teeth mostly affected were first permanent molars and second primary molars.

Cost assessment of a new oral care program in the intensive care unit to prevent ventilator-associated pneumonia.

OBJECTIVES: Ventilator-associated pneumonia (VAP) is the most frequent hospital-acquired infections in intensive care units (ICU). In the bundle of care to prevent the VAP, the oral care is very important strategies, to decrease the oropharyngeal bacterial colonization and presence of causative bacteria of VAP. In view of the paucity of medical economics studies, our objective was to determine the cost of implementing this oral care program for preventing VAP. MATERIALS AND METHODS: In five ICUs, during period 1, caregivers used a foam stick for oral care and, during period 2, a stick and tooth brushing with aspiration. Budgetary effect of the new program from the hospital's point of view was analyzed for both periods. The costs avoided were calculated from the incidence density of VAP (cases per 1000 days of intubation). The cost study included device cost, benefit lost, and ICU cost (medication, employer and employee contributions, blood sample analysis…). RESULTS: A total of 2030 intubated patients admitted to the ICUs benefited from oral care. The cost of implementing the study protocol was estimated to be €11,500 per year. VAP rates decreased significantly between the two periods (p1 = 12.8% and p2 = 8.5%, p = 0.002). The VAP revenue was ranged from €28,000 to €45,000 and the average cost from €39,906 to €42,332. The total cost assessment calculated was thus around €1.9 million in favor of the new oral care program. CONCLUSION AND CLINICAL RELEVANCE: Our study showed that the implementation of a simple strategy improved the quality of patient care is economically viable. TRIAL REGISTRATION: NCT02400294.

[Private spending on oral health in Brazil: analysis of data from the Family Budgets Survey, 2008-2009]. / Gastos privados com saúde bucal no Brasil: análise dos dados da Pesquisa de Orçamentos Familiares, 2008-2009.

The aim was to analyze Brazilians' private spending on dental care and oral hygiene products. Data were analyzed from 55,970 households in the Family Budgets Survey, 2008-2009. Expenditures were analyzed by major geographic region, state, state capital, and household socioeconomic and demographic characteristics (sex, age, head-of-household's skin color and schooling, per capita household income, and presence of elderly in the household). Brazilians spent an average of BRL 42.19 per year on dental care and BRL 10.27 on oral hygiene products. The study detected social inequalities in the distribution of these expenditures according to household residents' characteristics and the different geographic regions, states, and state capitals. The current study evidenced quantitative and specific details on Brazilians' spending on dental care and oral hygiene products. Monitoring and assessment of these expenditures are fundamental for evaluating and orienting public policies in oral health.

Portuguese self-reported oral-hygiene habits and oral status.

BACKGROUND: Good oral health is essential for good general health and quality of life. In Portugal, there are few studies on oral-health habits and the population's perceptions of this behaviour. OBJECTIVE: The main purpose of this study was to characterise the Portuguese population's self-reported oral-health status, habits and perceptions, as well as their demands regarding national oral health-care services. METHODS: A randomised group of 1,395 individuals, > 15 years of age, was selected as a representative sample of the Portuguese population. Face-to-face interviews were conducted, based on a structured questionnaire with closed and semi-closed questions. The data were submitted for statistical analysis using SPSS. RESULTS AND DISCUSSION: A sample of 1,102 individuals answered the questionnaire. The great majority of the sample (97.6%) brushed their teeth daily, 70.3% had lost permanent teeth and 6.4% were edentulous. The loss of permanent teeth was statistically associated with poor oral-hygiene habits (P < 0.01). Moreover, 50.1% of the participants had experienced difficulty eating and/or drinking, 18% had felt ashamed of the appearance of their teeth and 69.3% had experienced toothache or gingival pain. A reduction in visits to a dentist in the previous 12 months was identified mainly for people from a lower social class (31.2%) and older people (29.4%). CONCLUSION: Evidence suggests that oral diseases might be more prevalent in Portuguese adults than the European average. Efforts should be made to promote good oral-hygiene habits among older people and people from lower social classes.

Gastos privados com saúde bucal no Brasil: análise dos dados da Pesquisa de Orçamentos Familiares, 2008-2009 / Private spending on oral health in Brazil: analysis of data from the Family Budgets Survey, 2008-2009 / Gastos privados con la salud bucal en Brasil: análisis de datos de la Encuesta de Presupuestos Familiares, 2008-2009

Resumo: O objetivo foi analisar os gastos privados com assistência odontológica e produtos de higiene bucal dos brasileiros. Foram analisados dados de 55.970 domicílios pesquisados na Pesquisa de Orçamentos Familiares de 2008-2009. Os gastos foram descritos segundo macrorregiões, estados e capitais do Brasil e de acordo com características socioeconômicas e demográficas dos domicílios (sexo, idade, cor da pele e escolaridade do chefe, renda domiciliar per capita e presença de idoso no domicílio). Os brasileiros gastaram em média no ano R$ 42,19 com serviços de assistência odontológica e R$ 10,27 com produtos de higiene bucal. Desigualdades sociais na distribuição desses gastos segundo as características dos moradores dos domicílios e segundo as diferentes macrorregiões, estados e capitais do país foram encontradas. O presente estudo evidenciou com detalhes quanto e com o que gastam os brasileiros com assistência odontológica e com produtos de higiene bucal. O monitoramento e avaliação desses gastos são condições fundamentais para avaliação e orientação de políticas públicas em saúde bucal.

Abstract: The aim was to analyze Brazilians' private spending on dental care and oral hygiene products. Data were analyzed from 55,970 households in the Family Budgets Survey, 2008-2009. Expenditures were analyzed by major geographic region, state, state capital, and household socioeconomic and demographic characteristics (sex, age, head-of-household's skin color and schooling, per capita household income, and presence of elderly in the household). Brazilians spent an average of BRL 42.19 per year on dental care and BRL 10.27 on oral hygiene products. The study detected social inequalities in the distribution of these expenditures according to household residents' characteristics and the different geographic regions, states, and state capitals. The current study evidenced quantitative and specific details on Brazilians' spending on dental care and oral hygiene products. Monitoring and assessment of these expenditures are fundamental for evaluating and orienting public policies in oral health.

Resumen: El objetivo fue analizar los gastos privados con asistencia odontológica y productos de higiene bucal de los brasileños. Se analizaron datos de 55.970 domicilios seleccionados en la Encuesta de Presupuestos Familiares de 2008-2009. Los gastos fueron descritos según macrorregiones, estados y capitales do Brasil, y de acuerdo con características socioeconómicas y demográficas de los domicilios (sexo, edad, color de piel y escolaridad del cabeza de familia, renta domiciliaria per cápita y presencia del anciano en el domicilio). Los brasileños gastaron de media durante el año R$ 42,19 en servicios de asistencia odontológica y R$ 10,27 con productos de higiene bucal. Se hallaron desigualdades sociales en la distribución de esos gastos, según las características de los residentes de los domicilios, y conforme las diferentes macrorregiones, estados y capitales del país. El presente estudio evidenció con detalle cuánto y en qué gastan los brasileños respecto a la asistencia odontológica y productos de higiene bucal. El monitoreo y evaluación de estos gastos son condiciones fundamentales para la evaluación y orientación de políticas públicas en salud bucal.

Framing Young Childrens Oral Health: A Participatory Action Research Project.

BACKGROUND AND OBJECTIVES: Despite the widespread acknowledgement of the importance of childhood oral health, little progress has been made in preventing early childhood caries. Limited information exists regarding specific daily-life and community-related factors that impede optimal oral hygiene, diet, care, and ultimately oral health for children. We sought to understand what parents of young children consider important and potentially modifiable factors and resources influencing their children's oral health, within the contexts of the family and the community. METHODS: This qualitative study employed Photovoice among 10 English-speaking parents of infants and toddlers who were clients of an urban WIC clinic in North Carolina. The primary research question was: "What do you consider as important behaviors, as well as family and community resources to prevent cavities among young children?" Five group sessions were conducted and they were recorded, transcribed verbatim and analyzed using qualitative research methodology. Inductive analyses were based on analytical summaries, double-coding, and summary matrices and were done using Atlas.ti.7.5.9 software. FINDINGS: Good oral health was associated with avoidance of problems or restorations for the participants. Financial constraints affected healthy food and beverage choices, as well as access to oral health care. Time constraints and occasional frustration related to children's oral hygiene emerged as additional barriers. Establishment of rules/routines and commitment to them was a successful strategy to promote their children's oral health, as well as modeling of older siblings, cooperation among caregivers and peer support. Community programs and organizations, social hubs including playgrounds, grocery stores and social media emerged as promising avenues for gaining support and sharing resources. CONCLUSIONS: Low-income parents of young children are faced with daily life struggles that interfere with oral health and care. Financial constraints are pervasive, but parents identified several strategies involving home care and community agents that can be helpful. Future interventions aimed to improve children's oral health must take into consideration the role of families and the communities in which they live.

Socioeconomic inequalities and determinants of oral hygiene status among Urban Indian adolescents.

OBJECTIVES: To assess the socioeconomic inequalities in oral hygiene and to explore the role of various socioeconomic and psychosocial factors as determinants of these inequalities among adolescents residing in Delhi National Capital Territory. METHODS: A cross-sectional study was conducted among 1386 adolescents aged 12-15 years from three different socioeconomic groups according to their area of residence (middle-class areas, resettlement colonies and urban slum colonies). Level of oral hygiene was examined clinically using the Simplified Oral Hygiene Index (OHI-S), and an interviewer-administered questionnaire was used to measure key socio-demographic variables and psychosocial and health-related behaviours. Logistic regression analysis tested the association between area of residence and poor oral hygiene. RESULTS: Poor oral hygiene was observed in 50.2% of the adolescents. There was a socioeconomic gradient in poor oral hygiene, with higher prevalence observed at each level of deprivation. These differences were only partly explained, and the differences between adolescent groups remained statistically significant after adjusting for various demographic variables, standard of living, social capital, social support and health-affecting behaviours (OR: 1.96, 95% CI: 1.30-2.76; and OR: 2.50, 95% CI: 1.60-3.92 for adolescents from resettlement colonies and urban slums, respectively, than middle-class adolescents). CONCLUSION: Area of residence emerged as a strong socioeconomic predictor of prevalence of poor oral hygiene among Indian adolescents. Various material, psychosocial and behavioural factors did not fully explain the observed inequalities in poor oral hygiene among different adolescent groups.

Effectiveness, cost-effectiveness and cost-benefit of a single annual professional intervention for the prevention of childhood dental caries in a remote rural Indigenous community.

BACKGROUND: The aim of the study is to reduce the high prevalence of tooth decay in children in a remote, rural Indigenous community in Australia, by application of a single annual dental preventive intervention. The study seeks to (1) assess the effectiveness of an annual oral health preventive intervention in slowing the incidence of dental caries in children in this community, (2) identify the mediating role of known risk factors for dental caries and (3) assess the cost-effectiveness and cost-benefit of the intervention. METHODS/DESIGN: The intervention is novel in that most dental preventive interventions require regular re-application, which is not possible in resource constrained communities. While tooth decay is preventable, self-care and healthy habits are lacking in these communities, placing more emphasis on health services to deliver an effective dental preventive intervention. Importantly, the study will assess cost-benefit and cost-effectiveness for broader implementation across similar communities in Australia and internationally. DISCUSSION: There is an urgent need to reduce the burden of dental decay in these communities, by implementing effective, cost-effective, feasible and sustainable dental prevention programs. Expected outcomes of this study include improved oral and general health of children within the community; an understanding of the costs associated with the intervention provided, and its comparison with the costs of allowing new lesions to develop, with associated treatment costs. Findings should be generalisable to similar communities around the world. The research is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), registration number ACTRN12615000693527; date of registration: 3rd July 2015.

A qualitative study of the meaning of oral health and self-care for 40 Dunedin residents living on lower incomes.

BACKGROUND AND OBJECTIVES: This project extends studies of oral health cultures for lower income families by identifying the participants' meaning of oral health self-care, barriers to its attainment, and suggestions for its improvement. METHODS: Forty open-ended interviews were conducted with Dunedin residents purposively selected from a variety of ages, backgrounds and ethnicities. Transcribed interviews were analysed thematically. RESULTS: Five key themes emerged: (1) oral health understandings for self and wider family groups; (2) the complexity of understanding cost in relation to oral self-care; (3) oral self-care tools and daily oral health routines; (4) relationships with oral health workers and the meaning of good and bad care provision; and (5) the State's involvement in oral health. CONCLUSIONS: Participants valued good oral health and were knowledgeable about it, but cost was the primary barrier to care.

Clinical and cost effectiveness of enhanced oral healthcare in stroke care settings (SOCLE II): a pilot, stepped wedge, cluster randomized, controlled trial protocol.

RATIONALE: Stroke-associated pneumonia, a leading cause of hospital-acquired infection after stroke, affects a fifth of stroke survivors annually. Associated with increased risk of death and poorer rehabilitation outcomes, research suggests a possible relationship between stroke-associated pneumonia and patients' oral health. AIM: The aim of this study is to evaluate the feasibility of a randomized controlled trial of the clinical and cost effectiveness of enhanced oral healthcare vs. usual oral healthcare for people in stroke care settings. DESIGN: Our pilot, multicentered, pragmatic, stepped wedge, cluster randomized controlled trial oral healthcare [Stroke Oral healthCare pLan Evaluation (SOCLE II)] will compare enhanced oral healthcare intervention and usual oral healthcare. Over 13 months, across 4 wards, we seek to recruit 400 patients (estimating an average of 23 beds per site and a 50% recruitment rate) and 60 nursing staff (estimating an average of 20 members of staff per site and a 75% recruitment rate). Initially, control data (usual oral healthcare) will be collected from all sites. In a randomized, stepped manner, wards will convert to deliver the enhanced oral healthcare intervention. STUDY OUTCOME(S): Outcomes will be captured across dimensions of care (as recommended for evaluations of complex interventions) at baseline and weekly thereafter. Primary outcomes are pneumonia (patients), knowledge and attitudes (staff), and specialist dental referrals (service). Secondary outcomes include oral health quality of life, plaque, antibiotics, length of stay, death (patients), use of oral healthcare equipment and products, completed assessments, and documented oral healthcare plans (staff). DISCUSSION: As one of the first stepped wedge, cluster randomized, controlled trials in stroke care mapping of the complex intervention, our choice of primary and secondary outcomes and choice of trial design are described.