Oral Health Knowledge, Attitudes, Practices, and Literacy of Pregnant Women: A Scoping Review.

PURPOSE: Pregnancy is a state particularly sensitive to oral pathologies (periodontal and decay). The oral health status of pregnant women can have an impact on the outcome of the pregnancy and the oral health of the child to come. As in the general population, the oral health of pregnant women is socially determined and dependent on psychosocial factors, including factors related to health behaviours. Research into the determinants of oral health in pregnant women will allow a better understanding of the mechanisms of action specific to this period of perinatality. MATERIALS AND METHODS: The methodology of a scoping review was selected with the objective of investigating the contribution of knowledge, attitudes, practices (KAP) and oral health literacy on pregnant women's oral health. RESULTS: Of the 67 articles selected, 52 studied the 'knowledge' component, 27 the 'attitude' (including the perception and beliefs concerning health), and 54 the 'practice' component, while 6 articles examined literacy. The KAP components were studied in relation to socioeconomic determinants, oral health status, healthcare utilisation and oral health literacy. The level of oral health literacy of pregnant women is strongly related to their living environment and socioprofessional level which influences their attitudes and practices. Woman's oral health practices before pregnancy can be a predictor of her practices during pregnancy. CONCLUSION: The complex nature of the attitude component (locus of control, sense of self-efficacy, perceived importance) is little discussed. The heterogeneity and exhaustiveness of topics related to KAP raises the question of how to more accurately assess KAP in pregnant women in a valid, reproducible, and transferable manner and the need to build a structured oral health consensus body of work. This review is a first step towards identifying the psychosocial factors that are essential for developing a model of educational intervention in oral health that combines the process of behavioural change and decision making while taking into account the concept of empowerment, and with the aim of reducing social inequalities in health.

Determinants of maternal and household social inequalities of dental caries among Senegalese children in the Department of Pikine.

Introduction: the problematic of social Inequalities in oral health remains a global concern; it constitutes evidence of social injustice. The present work aims to study the determinants of maternal and household social inequalities of children´s dental caries in Pikine. Methods: cross-sectional epidemiological survey has been conducted in the department of Pikine, Senegal on 315 children aged 3 to 9 and their mothers. The clinical data on children´s caries have been obtained by clinical examination and the socio-economic data by a questionnaire submitted to mothers. Pearson chi-square and trend tests as well as a logistic model were used in the data analysis. Results: the prevalence of dental caries in children was 64.8% and the mixed decayed, filled, missing (DFM) index was 2.5 (±2.7). The trend test showed significant inequalities in the prevalence of dental caries according to level of studies (p<0.001), profession (p<0.010) and contacts frequency (p<0.001) of mothers; the level of wealth (p<0.001) and structure (p<0.005) of households. According to the logistic regression model, the level of secondary or university education [OR (IC 95%) = 0.59 (0.33'>OR (IC 95%) = 0.59 (0.33-0.93)] or social network dynamism [OR (IC 95%) = 0.32(0.15'>OR (IC 95%) = 0.32(0.15-0.67)] of mothers; as well as wealthy families [OR (IC 95%) = 0.23(0.08'>OR (IC 95%) = 0.23(0.08-0.64) were associated to fewer risks of dental caries among children. Conclusion: some socio-economic characteristics of the mother and the household social conditions are identified as determinants of dental caries social inequalities in Children. Proportionate universalism may be a good approach to reduce this problematic in Pikine.

Socio-Economic Determinants of Dental Service Expenditure: Findings from a French National Survey.

(1) Background: This study investigated how individual enabling resources influence (i) their probability of using dental services and (ii) consumers' expenditure on dental treatment. (2) Methods: Data were derived from a self-administered national health survey questionnaire and from expenditure data from national health insurance. Multiple linear regression methods were used to analyze entry into the dental health system (yes/no) and, independently, the individual expenditure of dental care users. (3) Results: People with the highest incomes were more likely to use dental service (aOR = 1.59; 95% CI = 1.28, 1.97), as were those with complementary health insurance and the lowest deprivation scores. For people using dental services, good dental health status was associated with less expenditure (-70.81 EUR; 95% CI = -116.53, -25.08). For dental service users, the highest deprivation score was associated with EUR +43.61 dental expenditure (95% CI = -0.15; 87.39). (4) Conclusion: Socioeconomic determinants that were especially important for entry into the dental health service system were relatively insignificant for ongoing service utilization. These results are consistent with our hypothesis of a dental care utilization process in two steps. Public policies in countries with private fees for dentistry should improve the clarity of dental fees and insurance payments.

Which determinants should be considered to reduce social inequalities in paediatric dental care access? A cross-sectional study in France.

Better access to dental care through systemic and educational strategies is needed to lessen the burden of disease due to severe early caries. Our study aims to describe family characteristics associated with severe early caries: parental knowledge, attitudes, practices in oral health and socio-demographic factors. For this cross-sectional study, 102 parents of children aged under 6 years with severe early caries and attending paediatric dentistry service in France completed a questionnaire during face-to-face interviews. Caries were diagnosed clinically by calibrated investigators, using the American Academy of Paediatric Dentistry criteria, and dental status was recorded using the decayed, missing, and filled teeth index. The majority of children were from underprivileged backgrounds and had poor oral health status, with a median dmft index of 10. Parents highlighted the difficulty of finding suitable dental care in private practices. Parents appeared to have good oral health knowledge and engaged in adapted behaviours but showed a low sense of self-efficacy. They perceived the severity of early caries as important but the susceptibility of their child as moderate. The study affirmed the importance of improving the accessibility of paediatric dental care and developing educational strategies to enhance the knowledge, skills, and oral health practices of families.

Implementation of a Medical Ethics Course in Undergraduate Dental Education and Assessment of Knowledge and Attitudes.

OBJECTIVES: A medical ethics course was launched in 2012 in a French University Dental School. We compared knowledge and attitudes, before and after implementation of that course. The aim of this study was to compare students who received an ethics course (third year) to those who did not have such training, however, most of them did have some clinical traineeship. MATERIALS AND METHODS: An anonymous questionnaire was sent to the second-, third-, and sixth-year students. It comprised questions with Likert item format answers and clinical vignettes with open responses. The results were analyzed by two approaches: a statistical analysis (chi-square or Fischer exact tests) and a content analysis using a predefined grid. RESULTS: A total of 299 respondents replied (75% students) the questionnaire. The analysis showed a statistically significant association between knowledge of the law and information procedures (P < 0.0001), access to medical files (P = 0.004), and recording consent (P = 0.049). It was also significant between knowledge of the law and the principles of biomedical ethics (P < 0.0001 for autonomy and beneficence). The third-year students could state the principles of medical ethics with their percentage always greater than the sixth-year students. After the third year, the students' attitudes switched from a social to a medical emphasis, and their point of view regarding patient's autonomy evolved. Patient's refusal of care raised potential conflicts between autonomy, professional judgment, information, and consent. CONCLUSION: Ethics teaching could offer a way to turn positive attitudes into real competencies and should be considered at an early stage.

Impact of fees on access to dental care: evidence from France.

BACKGROUND: For financial reasons, dental prosthetics is one of the major unmet dental healthcare needs [Financial-SUN (F-SUN)]. Private fees for dental prosthetics result in significant out-of-pocket payments for users. This study analyzes the impact of geo-variations in protheses fees on dental F-SUN. METHODS: Using a nationwide French declarative survey and French National Health Insurance administrative data, we empirically tested the impact of prosthetic fees on dental F-SUN, taking into account several other enabling factors. Our empirical strategy was built on the homogeneous quality of the dental prosthesis selected and used to compute our price index. RESULTS: Unmet dental care needs due to financial issues concern not only the poorest but also people with middle incomes. The major finding is the positive association between dental fees and difficulty in gaining access to dental care when other enabling factors are taken into account (median fee in the highest quintile: OR = 1.35; P value = 0.024; 95% CI 1.04-1.76). People with dental F-SUN are those who have to make a greater financial effort due to a low/middle income or a lack of complementary health insurance. For identical financial reasons, the tendency to give up on healthcare increases as health deteriorates. CONCLUSIONS: The results underscore the need for fee regulation regarding dental prosthetics. This is in line with the current French government dental care reform.

Evaluation of children's participation in a national dental programme in France.

OBJECTIVES: The current national oral health programme for children in France, called the DHE "Dental Health Examination," began in 2007. The aims of the current study were to evaluate the efficiency and effectiveness of the DHE programme in improving resource allocation to preventive dental services and providing access to dental care, especially for the children who need it most. The main questions were as follows: How many children participate in it? Does it reach the children who need it most? And does it save dental care costs? METHODS: The study examined data for 1937 children aged 6-16 years. Data came from two data sets: (a) a 2010 French self-reported survey on health, health care and insurance; and (b) the data set of the National Health Insurance Fund on healthcare consumption, based on reimbursement data to families and payments to providers; this data set contains information on healthcare expenditures. We investigated participation in the DHE programme, the wider use of dental care services and the total amount spent on dental care in 2010, by dental health status and socio-demographic characteristics. Data analysis used multiple logistic and linear regressions. RESULTS: Children in households with higher income were more likely to participate in the DHE programme (OR = 3.09, 95% CI [1.78, 5.36]). Families with higher incomes were more likely to use dental care (OR = 2.23, 95% CI [1.40, 3.55]). Households with private complementary health insurance utilized more children's dental care services than households without it (OR = 2.79, 95% CI [1.04, 7.49]). Families that were aware of the DHE prevention programme were more likely to utilize dental care (OR = 1.77, 95 % CI [1.34, 2.33]) and had lower dental care expenses (coeff. = -142.93, 95% CI [-207.68, -78.18]). CONCLUSION: Financial barriers remain the major obstacle to dental care utilization in France, even with DHE, a free secondary prevention programme aimed at all French children. Participation in the DHE programme is associated with better access to dental care and with lower costs for both the National Health Insurance Fund and participating households.

Sociodemographic factors associated with the dental health of persons with diabetes in France.

This paper describes and compares the oral health status among people with and without diabetes in France, and analyzes the related socioeconomic factors. The study is based on data from the cross-sectional national health survey conducted in France from 2002 to 2003, which included 19,231 people over 35 years of age, among whom 1,111 reported having diabetes. Data were collected through interviews that inquired about oral health status and use of dental care services, income, educational level, health insurance, place of residence, and birthplace. The prevalence of oral health problems was higher among subjects who had diabetes, compared with those who were nondiabetic (16.4% vs. 13.4%). Dental care utilization during the survey period was reported to be 8.7% among subjects who were diabetic versus 12.9% among those who were nondiabetic. The subjects with diabetes were more likely to have dental problems (OR = 1.47, CI = 1.03-2.08) and wear removable dentures (partial and complete) when their income was lower (OR = 2.17, CI = 1.52-3.10). There were social inequalities in oral health among people with diabetes in France according to income level.