Study protocol for a pilot quasi-experimental study on oral health education for nurses and community health workers in Nigeria.

Introduction: The primary health care system provides an ideal setting for the integration of oral health into general health care as well as equitable access to oral health care. However, the limited oral health knowledge of primary health care workers necessitates appropriate training before they can participate in health promotion efforts. This pilot training was designed to examine the impact of the Oral Health Education module for Nurses and Community Health Care Workers on their oral health awareness and referral practices. Methods: This study will utilize a quasi-experimental design (pre-and post with a non-equivalent control group) to assess the impact of a five-day pilot oral health education program on the knowledge and referral practices of Nurses and Community Health Workers in primary health care centers in three states in Nigeria-(Lagos, Oyo, and Kano). The training modules were developed based on the six iterative steps described in the intervention mapping framework - needs assessment, highlighting program objectives and outcomes, selection of theory and mode of intervention, designing program based on theory, designing implementation plans, and developing an evaluation plan. Only the intervention group will participate in the full educational training sessions but both groups will complete the pre-and post-intervention questionnaires. Discussion: This pilot training combined the standardized training modules from the recently launched "Oral Health Training Course for Community Health Workers in Africa" and a newly developed maternal and child oral health module by our group using an evidence-based approach. To the best of our knowledge, this is the first program to examine the impact of the standardized OpenWHO modules. The success of this training will lay the foundation for developing a sustained channel for providing oral health education at the primary health care level in Nigeria, West Africa, and Africa.

A study protocol for a single-centred randomized trial to investigate the effect of pre-treatment communication methods on dental anxiety among adult dental patients.

Objective: Optimal oral health is an essential component of good quality of life. However, this may be hindered by dental anxiety (DA), thereby, affecting the utilization of dental services. DA could be alleviated by pre-treatment information; however, the method of delivering this information is yet to be explored. It is, therefore, necessary to assess the modes of presenting pre-treatment information to ascertain the one with significant effect on DA. This will improve treatment outcomes and quality of life for individuals. Hence, the primary objective is to assess the effect of audiovisual and written forms of pre-treatment information on DA, while the secondary objective will compare the subjective and objective methods of assessing DA with psychometric anxiety scale (Index of Dental Anxiety and Fear (IDAF)-4C+) and salivary alpha-amylase respectively. Study design: Single-centred, single-blind, parallel-group, four-arm randomized clinical trial. Methods: The study will compare the effects of audiovisual and written forms of pre-treatment information on DA among adults. Patients 18 years and above scheduled for dental treatment will be screened for eligibility. Written informed consent will be sought before participation. Participants will be allocated randomly using block randomization, to the groups; G1: audiovisual and G2: a written form of pre-treatment information. At the visit, participants will complete the DA questionnaires (IDAF-4C+, Modified Dental Anxiety Scale and Visual Analogue Scale). Physiological anxiety-related changes of salivary alpha-amylase will be measured using a point-of-care kit (iPro oral fluid collector) at baseline, and 10 min after intervention. Furthermore, blood pressure will be taken at baseline and 20 min into the treatment. The mean changes of physiologic anxiety levels and 95% confidence intervals will be compared between the methods of pre-treatment information. Discussion: This study hopes to establish pre-treatment information as a method for reducing DA among the populace. Also, to assess the relationship between questionnaire-based and physiologic methods of assessing DA.

Impact of oral hygiene habits on oral health-related quality of life of in-school adolescents in Ibadan, Nigeria.

Background: Recent evidence has shown that the prevalence of periodontal diseases is still high among adolescents and, thus, there is an impetus to promote good oral hygiene habits among them through schools. There is a need to provide baseline data on the oral hygiene habits of adolescents and how it impacts their oral health-related quality of life for appropriate intervention to be instituted. Moreover, oral health-related quality of life describes how oral health affects the daily activities of individuals; thus, it provides a holistic means of involving individuals in making decisions about their oral health including uptake of oral hygiene habits. Aim: To assess the impact of oral hygiene habits on adolescents' oral health-related quality of life. Methods: A cross-sectional study was conducted among 1,800 adolescents aged 14-18 years attending 36 Senior Secondary Schools in the metropolis of Ibadan, Nigeria. Data were collected using a self-administered questionnaire, which assessed students' sociodemographic characteristics, oral hygiene habits, and oral health-related quality of life with COHIP-SF19. Data obtained was analyzed with SPSS version 25 and the p-value was set at <5%. Results: The mean age of the adolescents was 15.16 (±1.16) years. Many 1,094 (60.3%) cleaned their teeth twice or more often daily with 126 (7.0%) cleaning after meals and 1,519 (84.4%) changing their tooth cleaning agent at three months intervals or less. About 1,215 (67.5%) spent three minutes or longer in cleaning their teeth. Only a few 238 (13.2%) cleaned interdentally and 137 (7.6%) used dental floss. The OHRQoL scores of the adolescents ranged from 9-76. A total of 1,612 (93.5%) had at least an impact on their OHRQoL. Those who cleaned their teeth more frequently (twice or more) were more likely to have better OHRQoL (OR = 1.6, 95% CI = 1.1-2.4, p = 0.025) and those who did not clean interdentally were more likely to have better OHRQoL (OR = 2.8, 95% CI = 1.2-6.5, p = 0.014) than others. Conclusion: The oral hygiene habits of the adolescents were suboptimal and those who cleaned their teeth twice or more often each day had fewer impacts on their OHRQoL, whereas those who engaged in interdental cleaning had higher impacts on their OHRQoL than others.

"Oral health as an important milieu for social and mental health": Perspectives of adolescents emerging from a qualitative study.

Background: Recent evidence showed that the prevalence of oral diseases is still high among adolescents in many developing countries, including Nigeria. It therefore has becomes pertinent to focus on appropriate oral health interventions to promote oral health among them. This necessitates investigating the perspectives of adolescents, who are the major stakeholders, on the importance of oral health as baseline data needed in planning appropriate primary interventions. Aim: The aim of the study was to explore the perspectives of adolescents on the importance of oral health. Methods: An explorative qualitative study was conducted among adolescents attending senior secondary school I (grade 10) in the metropolis of Ibadan, Nigeria. A total of 12 focus group discussions were conducted among 120 adolescents aged 14 to 19 years. The discussions were transcribed verbatim, and triangulation and organization, as well as thematic analysis, of data were carried out. Results: Some adolescents had positive perceptions of oral health and valued it as highly important, although some had contrary views and believed oral health was unimportant. Oral health is described as being integral to general health, is associated with eating and communication, is a means of survival and confidence building, and is a prelude to attract the opposite gender. Adolescents perceived the need for oral health education and dental treatment. Conclusion: Adolescents have mixed perspectives on the importance of oral health; while some valued it as highly important, others believed it was of no significance. Those who valued oral health as important described it as a milieu for general health, human survival, and social and mental health and thus requested for oral health promotion in schools.

Assessment of Atraumatic Restorative Treatment (ART) on the permanent dentition in a primary care setting in Nigeria.

OBJECTIVES: To assess the acceptability of ART and to evaluate on a longitudinal basis the survival rate of single surface occlusal ART restorations in the permanent dentition. DESIGN: Longitudinal Study of ART restorations. SETTING: Primary Oral Health Care Setting. PARTICIPANTS: Aged 8-19 years in a low socioeconomic community, Southwestern Nigeria. INTERVENTIONS/METHODS: Ninety-three ART restorations were applied on single surface occlusal caries by a dentist who had undergone training on ART. MAIN OUTCOME MEASURES: Six monthly follow-up of patients to evaluate restoration retention and marginal defect was conducted by an independent evaluator. RESULTS: Over 90.0% of the subjects had never undergone dental treatment, yet 63.0% perceived dental treatment as painful. After undergoing the treatment as many as 98.0% admitted that ART was not painful. On the question of their willingness to make recall visits, about 95.0% responded in the affirmative and about 96.0% reported that they would encourage others to come for treatment. The cumulative survival rate of single surface occlusal ART restorations after 2 years was 93.5% (SE=2.3%). CONCLUSIONS: ART was shown to be acceptable and effective in the management of single surface occlusal caries in the permanent dentition in these Nigerian children and adolescents outside the traditional clinical setting.

Satisfaction with dental condition and oral health-related quality of life of school-age children with dental pain in Ibadan, Nigeria.

OBJECTIVES: The aim of the study was to determine the association between oral health-related quality-of-life domains and satisfaction with dental condition of school-age children with dental pain in Ibadan, Nigeria. METHODS: This cross-sectional study was conducted among 1006 pupils aged 9-12 years who attended 18 randomly selected primary schools in Ibadan, Nigeria. An interviewer-administered questionnaire, Child Oral Impact on Daily Performances inventory in addition to oral examination was used to obtain data. Analysis was done with SPSS 23 and STATA 14 and p-value set at <0.05. RESULTS: The prevalence of self-reported dental pain was 10.2%. The mean Child Oral Impact on Daily Performances inventory score was 2.6(±7.2) overall and 9.8(±12.4) for pupils with pain. There was a greater impact on oral health-related quality of life of respondents who reported dental pain than in others (mean rank = 749.54 vs 475.4, U = 21,162, p < 0.001) compared to those with clinically assessed pain (mean rank = 541.21 vs 502.97, U = 6416, p = 0.489). Those who reported dental pain were more dissatisfied with their dental condition (odds ratio = 7.7, 95% confidence interval = 5.0-12.0, p < 0.001) compared to those with clinically assessed dental pain (odds ratio = 1.3, 95% confidence interval = 0.4-4.9, p = 0.687). The direct effect of pain on satisfaction with dental condition and Child Oral Impact on Daily Performances inventory was ß = 0.74 (standard error = 0.12, 95% confidence interval = 0.50-0.97, p < 0.001) and ß = 0.53 (standard error = 0.05, 95% confidence interval = 0.44-0.63, p < 0.001), respectively. The indirect effect was ß = 0.12 (standard error = 0.039, 95% confidence interval = 0.05-0.20, p = 0.001) and the total effect was ß = 0.86 (standard error = 0.11, 95% confidence interval = 0.64-1.08, p < 0.001); R 2 = 0.21. CONCLUSION: Self-reported dental pain significantly impacted the quality of life of the pupils to cause dissatisfaction with dental condition when compared to clinically assessed pain.

Clinical and sociodemographic factors associated with oral health knowledge, attitude, and practices of adolescents in Nigeria.

OBJECTIVES: The institution of appropriate oral health promotion programs targeted at adolescents in schools in developing countries requires baseline information on their oral health knowledge, attitude, and practices as well as associated factors influencing it, which are unknown. This study assessed clinical and sociodemographic factors associated with oral health knowledge, attitude, and practices of adolescents in Ibadan, Nigeria. METHODS: Two-thousand and ninety-seven students aged 12-18 years were recruited from 30 randomly selected secondary schools in a cross-sectional study conducted in Ibadan, Nigeria. Data were obtained through a questionnaire on oral health knowledge, attitude, and practices, and sociodemographic characteristics. Oral examination was conducted to assess the clinical oral condition of the adolescents. Data were analyzed with SPSS. The higher the percentage scores, the better the oral health knowledge, attitude, and practices, and overall awareness of oral health. RESULTS: The oral health knowledge score ranged from 0% to 60%; mean oral health knowledge score was 15.1% (±6.6%). The oral health attitude score ranged from 0% to 91.3%; mean oral health attitude score was 44.5% (±14.3%). The oral health practices score ranged from 0% to 88.9%, and mean oral health practices score was 42.5% (±13.8%). The mean oral health knowledge, attitude, and practices score was 43.8% (±11.4%). A total of 1537 (73.3%) participants had unhealthy periodontium and 98 (4.7%) had dental caries. Students who were 12-15 years (odds ratio = 1.7, 95% confidence interval = 1.4-2.0, p < 0.001), females (odds ratio = 1.2, 95% confidence interval = 1.0-1.5, p = 0.024), offspring of skilled workers (odds ratio = 1.5, 95% confidence interval = 1.1-2.0, p = 0.010), previously educated about oral health (odds ratio = 1.3, 95% confidence interval = 1.0-1.7, p = 0.023), consulted the dentist (odds ratio = 1.9, 95% confidence interval = 1.2-3.1, p = 0.009), or had unhealthy periodontal condition (odds ratio = 1.2, 95% confidence interval = 1.0-1.5, p = 0.042) were more likely to have higher oral health knowledge, attitude, and practices scores or awareness than others. CONCLUSION: Better knowledge, attitude, and practices score was associated with younger age group, higher occupational class, previous oral health education, dental consultation, and having unhealthy periodontal condition.