Platform for Better Oral health in Europe / La plateforme pour la santé orale en Europe

The Platform for Better Oral Health in Europe brings together five European organizations (Council of European Chief Dental Officers, Association for Dental Education in Europe, European Association of Dental Public Health, Pan European-International Association For Dental Research, Oral Health Foundation-UK) along with eighteen other associated European or national organizations. The platform aims to encourage oral health promotion and the prevention of oral diseases as fundamental components of good general health. The aim is thus to strengthen oral health promotion in Europe through integrating oral health into the relevant public health policies. It also aims to address the issue of oral health inequality, particularly among vulnerable populations such as children and adolescents, older adults, and people with particular needs. The platform is therefore a European-level resource for providing evidence-based information on best practice in oral health promotion and for guiding oral health policies. It also works to reinforce communication at the European level between stakeholders, policy makers, health professionals, and the public, in order to improve awareness of oral health issues.

La « plateforme pour une meilleure santé orale en Europe ¼ réunit six associations européennes (Council of European Chief Dental Officers, Association for Dental Education in Europe, European Association of Dental Public Health, Pan European-International Association For Dental Research, Oral Health Fondation-European Federation of Periodontology) en lien avec dix-neuf organisations européennes ou nationales associées. Elle a pour objectif d'encourager la promotion de la santé orale et la prévention des maladies bucco-dentaires en tant qu'éléments fondamentaux d'une bonne santé générale. L'objectif est aussi de renforcer la politique de promotion de la santé orale en Europe, y compris par l'intégration de la santé orale dans des politiques de santé publique pertinentes. Il s'agit également de prendre en compte la question des inégalités en matière de santé orale, notamment au sein des populations vulnérables comme les enfants et les adolescents, les personnes âgées et les personnes ayant des besoins spécifiques. La plateforme constitue ainsi une ressource au niveau européen pour fournir des informations fondées sur des preuves concernant les meilleures pratiques en promotion de la santé orale et pour l'orientation des politiques en matière de santé orale. Elle travaille aussi à développer les relations au niveau européen avec les parties prenantes, les décideurs politiques, les professionnels de santé, le public, afin d'améliorer la prise en compte des enjeux concernant la santé orale en Europe.

Implementation and impact of a dental preventive intervention conducted within a health promotion program on health inequalities: A retrospective study.

BACKGROUND: The objective of this retrospective survey was to evaluate after one year, the conditions and impacts of a dental sealant intervention conducted in New Caledonia, within a health promotion program. A greater or at least equivalent quality and impact of the intervention was expected for children living in socially deprived regions with the greatest health needs. METHODS: The study population was the schoolchildren, aged 6 years in 2016, who benefited from the dental sealant program (n = 2532). The study sample was randomly selected in 2017 from that population (n = 550). The children's dental status was evaluated at school in 2017 and compared with that recorded in 2016 during the sealant intervention allowing the calculation of the retention rates and one-year carious increment on first permanent molars. Socio-demographic variables (gender, public/private school) and conditions of sealant placement (school/dental office, presence of a dental assistant) were recorded. The carious increment was explained using a mixed multiple random-effects regression. A mediation analysis was conducted to assess the respective contributions of the retention rates and the region of origin on caries increment. RESULTS: The participation rate was very high (89%) and on average, children had 83% of their dental sealants present after one year, 31% fully and 52% partially present. Caries increment varied depending on the sealant retention rate as well as on the region (North, South, Islands). The mediation analysis showed that living in a deprived area (The Islands) was a strong determinant for high caries increment particularly when the retention rates were low. CONCLUSIONS: This study showed a high participation rate and acceptable effectiveness as measured with the one-year retention rates, for a fissure sealant intervention conducted in real-life conditions and integrated in a large health promotion program. Nevertheless, the intervention was not effective enough to totally balance the influence of health determinants, especially in socially deprived sectors characterized by greater dental needs.

[Oral health inequalities: Determinants of access to prevention and care in France]. / Inégalités en santé orale : déterminants de l'accès à la prévention et aux soins en France.

INTRODUCTION: Oral diseases are unequally distributed according to a social gradient, which now constitutes a major public health problem. Acting against oral health inequalities requires a better understanding of the underlying mechanisms in order to identify the appropriate solutions to improve access to oral health promotion and dental care for deprived populations. METHODS: A patient-centered model of health care access, describing the ideal interactions between individuals and the health care system was applied to the field of oral health in the French context. This model defines access to health care as the result of interactions between individuals and the health care system, in which health needs are perceived, health care is sought, health care structures are accessed and effectively used. Analysis is based on quantitative and qualitative bibliographic data acquired through an explanatory sociological approach. RESULTS: Socially deprived populations face many barriers preventing their access to dental care: the need for dental care is not necessarily perceived, and, when perceived, dental care is not immediately sought, accessibility to dental care structures is difficult and dental attendance is erratic. CONCLUSION: This review provides information to decision-makers in order to support regional health policies and to help implement public health strategies according to the principle of proportionate universalism. Two axes for action were identified, namely to integrate oral health promotion interventions within health promotion programmes and to gradually reorganize the dental care system to make it more accessible to everyone.

Social inequalities in oral health in a group of older people in a Middle Eastern country: a cross-sectional survey.

BACKGROUND AND OBJECTIVE: The percentage of Lebanese older people has increased considerably. Given that Lebanese seniors are marginalized in the health policy-making process, we suggest a high social inequality in oral health that has not been studied so far. The purpose of our study was to describe and compare oral health status in a group of Lebanese older people according to their socioeconomic status (SES) MATERIALS AND METHODS: Participants were recruited from three different primary health care clinics in Beirut, Lebanon. Data were collected from an administered questionnaire that included sociodemographic variables, perception of oral health, and regular dental visits. Oral examination included the number of missing and decayed teeth, the prosthetic status, and the number of functional dental units (FUs). The SES of the participants was determined by educational level, previous or actual work, and neighborhood level. RESULTS: 264 participants aged 71.4 ± 6.27 years (64.7% female) were included in the study. Regular dental visit, dental status, FU, and oral health perception were significantly related to the participants' place of residence, educational level, and work. Moreover, the mean number of missing teeth (p = 0.048) and decayed teeth (p = 0.018) was significantly elevated in the low SES. CONCLUSION: There is a clear socioeconomic inequality in oral health among the Lebanese older people. Further researches should explore the potential contribution of psychosocial and behavioral factors in explaining these disparities.

Psychometric characteristics of the "General Oral Health Assessment Index (GOHAI) ¼ in a French representative sample of patients with schizophrenia.

BACKGROUND: The "General Oral Health Assessment Index" (GOHAI) was widely used in clinical or epidemiological studies worldwide, as it was available for use in different languages. Therefore, the aim of this study was to evaluate the psychometric characteristics of the GOHAI in a representative sample of patients with schizophrenia. METHODS: A total of 90 schizophrenic patients (in-patients and out-patients) were recruited from the participants of the "buccodor study" (NCT02167724) between March and September 2015. They were selected using a random stratified sampling method according to their age, sex, or residential area (urban/rural area). GOHAI validity (construct, predictive, concurrent and known group validity) and internal consistency (reliability) were tested. Test-retest reliability was evaluated in 32 subjects. RESULTS: The mean age was 47.34 (SD = 12.17). Internal consistency indicated excellent agreement, with a Cronbach's α value of 0.82 and average inter-item correlation of 0.65. Intraclass correlation coefficients for test-retest reliability with 95% confidence intervals were not significantly different (p > 0.05). Construct validity was supported by three factor that accounted for 60.94% of the variance observed. Predictive validity was corroborated as statistically significant differences were observed between a high GOHAI score, which was associated with self-perceived satisfaction with oral health, lower age and high frequency of toothbrushing. Concurrent validity was corroborated as statistically significant relationships were observed between the GOHAI scores and most objective measures of dental status. For known group validity, they was no significant difference of the mean GOHAI score between out or in-patients (p > 0.05). CONCLUSION: Acceptable psychometric characteristics of the GOHAI could help caregivers to develop ways to improve the Oral Health related Quality Of Life of schizophrenic patients. TRIAL REGISTRATION: Clinical Trials Gov NCT02167724 . Date registered 17 June, 2014.

Dental status of new caledonian children: is there a need for a new oral health promotion programme?

BACKGROUND: Before implementing a new oral health promotion program in the French overseas territory of Nouvelle Calédonie, the health authorities needed recent data about dental status of the New Caledonian child population. OBJECTIVES: This study aimed to describe the dental status of 6, 9 and 12-yr-old New Caledonian children and to investigate the environmental and behavioural risk factors related to oral health. METHODS: A randomly selected sample of 2734 children (744 6-yr-olds, 789 9-yr-olds, and 1201 12-yr-olds) was examined clinically by seven calibrated investigators and participants responded to a questionnaire. The main variables were objective criteria about dental status and subjective criteria about experience of dental care, dental fear, self-perception of oral health, cultural or ethnic identity and environmental and behavioural risk factors. RESULTS: Overall, most of the children had infectious oral diseases: more than 50% had gingivitis, and 60% of 6- and 9 yr-olds had at least one deciduous or permanent tooth with untreated caries. The mean 12-yr-old number of decayed missing and filled teeth (DMFT) was 2.09±2.82. The number of carious lesions was related to the unfavourable lifestyle, deprived social status and no preventive dental care. Kanak, Polynesians and Caledonians (respectively 27%, 18% and 45% of the study sample) were more affected by caries than metropolitan French and Asian children. Children with many untreated carious lesions had negative perceptions of their oral health; they complained of chewing difficulty and had higher scores for dental anxiety. CONCLUSION: This study highlights the need for new strategies aimed at improving oral health and at reducing inequalities in New Caledonia. An oral health promotion program would need to be developed in connection with other health programmes using the common risk factor approach within the context of the local environment.

The pertinence of oral health indicators in nutritional studies in the elderly.

BACKGROUND AND AIM: Studies concerning the more appropriate criteria for evaluating oral health in relation to nutrition in the elderly vary greatly. There is a need to identify the most relevant criteria for classifying dental indicators of mastication in nutritional studies, so these indicators may be considered for epidemiological and clinical purposes. The aim of this study was to explore the associations between nutritional deficit and measures of oral health in a group of elderly. METHODS: A convenience sample of independent elderly aged 65 years or more attending two primary care clinics in Beirut, Lebanon was selected. Data were collected from a questionnaire including the Mini-Nutritional Assessment (MNA), Geriatric Oral Health Assessment Index (GOHAI) and questions about perception of xerostomia and chewing problems. The oral examinations recorded decayed, missing and filled teeth (DMFT), the prosthetic status and the number of functional units (FU). RESULTS: The sample was composed of 121 women (mean age: 71.59 ± 5.97 years) and 80 men (mean age: 72.74 ± 6.98 years). They were allocated to two groups: 85 participants suffering from malnutrition (MNA score < 17, n = 17) or at risk of malnutrition (17 < MNA score < 24, n = 68) and 116 participants with a normal nutritional status (MNA score ≥ 24). Parameters that explain MNA variations were perception of xerostomia (OR = 3.49, 95% CI [1.66-7.34]), number of FU (OR = 2.79, 95% CI [1.49; 5.22]), and GOHAI score (OR = 2.905, 95% CI [1.40; 6.00]). CONCLUSION: Further studies exploring factors affecting nutrition in the elderly should take into consideration perception of xerostomia, number of FUs and GOHAI score.

Comparison of the OHIP-14 and GOHAI as measures of oral health among elderly in Lebanon.

BACKGROUND: The respective abilities of the GOHAI and OHIP-14 to discriminate between aged patients with different levels of oral diseases have rarely been studied in developing countries. The aim of this study was to compare the discriminative abilities of the OHIP-14 and the GOHAI in an elderly Lebanese population, and particularly to identify persons with different masticatory function. METHODS: A sample of elderly, aged 65 years or more, living independently was recruited in two primary care offices in Beirut, Lebanon. Data were collected by means of personal interview and clinical examination. The Arabic OHIP-14 and GOHAI questionnaires were used after cultural adaptation for use in Lebanon. The internal consistency, reproducibility and concurrent validity were verified. To test their discriminative abilities, the ADD (GOHAI and OHIP) and SC (GOHAI and OHIP) scores were dichotomized according to the 25th and 75th percentile respectively and logistic regressions were conducted using socio-demographic, clinical and subjective explanatory variables. RESULTS: Two hundred and six participants were included; mean age was 72 years and 60% were women. Good psychometric properties were observed for both questionnaires for internal consistency (Cronbach's alpha>0.88), reproducibility (ICC>0.86) and concurrent validity. Strong correlations were found between GOHAI and OHIP-14 scores but a high prevalence of subjects with no impact was observed using the OHIP-14. Both questionnaires were able to discriminate between participants according to age, perception of temporomandibular joint (TMJ) pain or functional status as represented by the number of dental Functional Units (FU). GOHAI was more discriminant since it identified participants with high dental care needs: high numbers of decayed teeth, low numbers of teeth and socially deprived status. CONCLUSIONS: Lebanese elderly with high dental care needs and impaired oral health were identified more easily with the GOHAI. These results may guide the choice of dental indicators to use in a national geriatric survey.

Addressing children's oral health inequalities: caries experience before and after the implementation of an oral health promotion program.

OBJECTIVE: (1) To evaluate the dental status of 5-year-old children in Clermont-Ferrand (France) in 2009; (2) To measure changes in children's dental status between 2003 and 2009; and (3) To estimate the impact of an Oral Health Promotion (OHP) program implemented in nine schools since 2005. MATERIALS AND METHODS: All 5-year-olds attending public schools in deprived areas (n = 15) and six randomly selected other schools in Clermont-Ferrand were invited to participate. Dental status was recorded using d(3)mft, as in 2003. Parents responded to questions about their child's oral hygiene and provided socio-demographic information. RESULTS: Of children invited, 478 (77%) were examined. Mean dmft was 1.18 (SD 2.61); 27.6% had at least one tooth affected. Caries experience varied significantly with deprivation status, oral hygiene and household SES indicators. The only difference observed between 2003 and 2009 was an increase in the 'f' component (p < 0.001). Dental status had slightly deteriorated in areas characterized in 2003 by low caries levels (p=0.07). In deprived areas, mean dmft increased in schools without the OHP program (p = 0.04). Changes between 2003 and 2009 were studied at school level using Multiple Factorial Analysis; it tended to improve in four schools, which had the OHP program. Household indicators of SES changed little. Oral hygiene levels varied differently from one school to another. CONCLUSIONS: Caries experience was high, with large inequalities between children. No major differences were observed between 2003 and 2009. The OHP program has done little to reduce disparities in oral health, even if dental status improved in four schools.

Validation of a French version of the Child-OIDP index.

The Child-OIDP index is an indicator of oral health-related quality of life, which has been validated among 12-yr-old children in Thailand. The aim of this study was to assess the reliability, validity, and applicability of this questionnaire among French children. After translation and cultural adaptation, the Child-OIDP was tested on 414 10-yr-old children in France. The children completed the Child-OIDP in face-to-face interviews, were clinically examined, and answered questions evaluating their global self-rated oral health. Parents filled in a questionnaire concerning their socio-demographic background. An oral impact on daily life was reported by 73% of the children. The mean Child-OIDP score was 6.32 [standard deviation (SD) 8.22] and the median was 3.33. The internal reliability was confirmed with a Cronbach's alpha of 0.57. The retest procedure (n = 62) showed a satisfactory reproducibility (r = 0.81, kappa = 0.75). The index was shown to be a valid instrument. Construct validity was satisfactory as the Child-OIDP score increased when the children's perceived oral health decreased. The Child-OIDP score was able to discriminate between different socio-demographic groupings and varied according to dental status. This study showed that the Child-OIDP is applicable for use among children in France. It has promising psychometric properties but further research is required to evaluate its sensitivity to change.

Dental status and oral health quality of life in economically disadvantaged French adults.

Expansion of French health insurance coverage has increased funding for dental care for economically disadvantaged adults. This study aimed to measure clinical and self-perceived oral health, behaviors, and use of dental services by adults who were eligible for such coverage. The regional agency that gives administrative services for the health insurance funds provided a sample of 900 adults aged 35-44 years, insured through this program. We reached 805 of these adults by mail; of these 18% were surveyed and clinically examined. Self-perceived oral health was measured by the Global Oral Health Assessment Index (GOHAI) and participants' attitudes to dental health, by questionnaire. Decayed and Missing teeth constituted 40% of the DMFT. Participants reported poor oral health (63%), and 79% perceived a need for care, although they used dental services infrequently and had poor knowledge of available services. Cost of care and number of carious teeth were important predictors of the GOHAI.