Adolescents' self-reported experiences following a person-centred, theory-based educational intervention versus conventional education for improved oral hygiene: Analysis of secondary outcomes of a randomized field study.

AIM: To analyse adolescents' self-reported experiences and behavioural outcomes of a person-centred, theory-based intervention in comparison with conventional information/instruction for improved oral hygiene. MATERIALS AND METHODS: Data were derived from a prospective, multi-centred, two-arm, quasi-randomized field study focusing on the effectiveness of educational interventions for improved oral hygiene. Dental hygienists working within the Public Dental Service, Västra Götaland, Sweden, provided treatments, and adolescents with poor oral hygiene conditions were eligible for participation. The person-centred test intervention was based on social cognitive constructs, and motivational interviewing was used as an approach in communication. The control intervention included conventional information/instructions. Clinical examinations were performed, and questionnaires were distributed at baseline and at 6 months. Three-hundred and twelve patients were enrolled, and data from 276 patients, following treatment per protocol, were analysed. RESULTS: The test group was more satisfied with the education about gingivitis (very good: 61% vs. 37%) and communication during therapy (very good: 69% vs. 50%) and reported to a larger extent that they were much more careful regarding their oral hygiene after the treatment (30% vs. 15%) and had higher confidence about keeping up healthy gingival conditions, in comparison with the control group (all p < .01). CONCLUSIONS: The person-centred, theory-based intervention was superior in terms of adolescents' experiences of education and communication during therapy and self-reported oral hygiene behavioural outcomes at 6 months, in comparison with conventional information/instruction.

Correlation of self-esteem with oral hygiene behaviour and oral health status among adult dental patients.

Background: Self-esteem is a psychological construct that has been consistently linked to general and oral health. However, most studies interpolating self-esteem and oral health behaviour have been focused on children and adolescents, and there is a dearth of scientific literature on adults. Hence, this study, that is aimed to correlate self-esteem with oral hygiene behaviour and oral health status in Telugu-speaking adult dental patients. Methods: A cross-sectional study involving adult dental patients who were 35-44 years of age and visited the Government Dental Hospital in Hyderabad city, India, was conducted. Self-esteem was assessed using the Telugu-translated version of the Rosenberg Self-esteem Scale, oral health behaviour was determined using the Oral Hygiene Behaviour Index and oral health assessment was performed using the World Health Organization Dentition status, the modified Community Periodontal Index and the Loss of Attachment. Results: A total of 456 patients were included in this study. Most of the participants reported low self-esteem, with a mean score of 11.8 ± 2.7. Patients with primary school education reported higher self-esteem scores than those with high school and university education (p = 0.0001). Furthermore, low Oral Hygiene Behaviour Index scores (64.9%) in the study population and high Decayed, Missing, Filled Teeth scores in females (5.7 ± 4.4; p = 0.09) were noted. None of the variables (Decayed, Missing, Filled Teeth scores, Oral Hygiene Behaviour, gingival bleeding and Loss of Attachment) were significantly correlated with self-esteem. Multivariable regression analysis revealed that younger age, lower educational level and presence of dental caries resulted in higher odds for high self-esteem (p < 0.01). Conclusion: The findings indicated a significant association between self-esteem and oral health. Indivi-duals with dental caries had significantly higher odds for high self-esteem. Thus, this study emphasises the relevance of psychosocial factors, such as self-esteem, as the mediator of oral health.

Interconnectedness between periodontitis stage, oral hygiene habits, adherence to the Mediterranean diet and nutritional status in Dalmatian kidney transplant recipients: a cross-sectional study.

The aim of this cross-sectional study was to determine the associations between the Mediterranean diet (MeDi), nutritional status parameters, muscle strength, and periodontal status in Dalmatian kidney transplant recipients (KTRs). 89 KTRs were included in this analysis, 40 (45%) women, with a mean age of 61 years (IQR = 13) and a mean time since kidney transplantation of 5 years (IQR = 6.6). An OHIP-14 questionnaire and questionnaire-based periodontal history were obtained from all participants, a comprehensive periodontal examination was performed. Body composition data, anthropometric and clinical parameters were collected for each study participant. The Mediterranean Diet Serving Score (MDSS) was used to assess MeDi adherence, and handgrip strength was measured with a hand dynamometer. Our results showed low adherence to MeDi in KTRs (28%) and almost 50% of KTRs suffer from severe forms of periodontitis. We also found a low OHIP-14 score and poor oral hygiene habits. KTRs with a less severe form of periodontitis had higher muscle mass and handgrip strength. MDSS score was associated with a higher number of teeth, and everyday cereal intake was inversely associated with the periodontitis stage. Our results demonstrate the associations between nutritional status, muscle strength, dietary habits, and periodontal health in Dalmatian KTRs.

Oral health status and practices of 6- to 7-year-old children in Amman, Jordan: a cross-sectional study.

BACKGROUND: Dental caries affects the majority of children in Jordan, with some evidence of its prevalence steadily increasing. Previous studies have shown that families struggle to establish good oral health practices. The aim of this study was to evaluate the current oral health status and practices of 6- to7-year-old children in Amman, Jordan.r METHODS: A cross-sectional cohort study. The sample consisted of 6- to 7-year-old children attending six randomly selected schools in Amman, Jordan. Measures collected were: I) Caries experience (d3mft/D3MFT), II) Oral hygiene, measured using the Simplified Oral Hygiene Index, III) Dietary, toothbrushing, and dental attendance practices, measured using diaries and parental questionnaires, IV) Participants' basic characteristics: age, education and employment. Data were analysed using SPSS20. RESULTS: In total, 942 children were recruited. Four hundred and fifty-seven were boys, 485 were girls. Their average age was 6.5 years. Eighty-nine percent had decay in their primary teeth. Mean d3mft was 5.1(1 (range = 0-12, SD = 2.9). Only 8% of carious teeth were restored. Mean DMFT score was 0.3 (range = 0-4, SD = 0.8). Mean debris score was 1.07 (range = 0-3, SD = 0.37). Children indicated that they brush their teeth 1.6 times a day (range = 0-3, SD = 0.6). The majority (81%) were unsupervised. Sixty-seven percent of parents did not know the appropriate fluoride toothpaste concentration. Children were having 1.5 sugary snacks in-between their meals (Range = 1-6, SD = 1.1). They scored a mean of 2.5 (Range = 0-5.87, SD = 1.7) in sweetened drinks intake (recommended ≤ 1) and 2.8 (Range = 0-18.57, SD = 1.5) in non-core food intake (recommended ≤ 2) on a dietary questionnaire. Most parents (84%) indicated that their child attends the dentist only when in pain, and 18% indicated that their child is extremely afraid of dentists. Only 32% and 18% were familiar with fluoride varnish and fissure sealants, respectively. Regression analysis revealed that debris score and dental attendance were reliable predictors of caries experience. CONCLUSIONS: Six- to seven-year-old children in Amman, Jordan have a high caries experience. Most show signs of poor oral hygiene, excessive intake of cariogenic foods, and symptomatic dental attendance. Their parents lack knowledge on fluoride varnish and fissure sealants. There is a need for oral health promotion tailored to this cohort's need.

Top-down self-regulation processes as determinants of oral hygiene self-care behaviour: A systematic scoping review.

OBJECTIVES: Understanding the psychological mechanisms that moderate oral hygiene self-care behavior is anticipated to benefit efforts to change such behavior. Top-down self-regulatory (TSR) processes represent one group of relatively unexplored, yet potentially influential, moderating factors. This systematic scoping review aims to explore whether there is evidence that TSR processes moderate oral hygiene self-care engagement within the current literature. METHODS: CINAHL, The Cochrane Library, Embase, MEDLINE, PsycINFO, Scopus, and Web of Science databases were searched up to April 2020 for articles that compared measures of TSR processes (such as self-monitoring, inhibitory control, and task switching) to oral hygiene self-care behavior, or tested interventions that aimed to change or support TSR processes. RESULTS: The search returned 6626 articles, with 25 included in the final sample. Weak evidence supported both the role of TSR processes as moderators of interdental cleaning and the value of interventions targeting self-monitoring of interdental cleaning behavior. Overall, methodological limitations rendered the findings somewhat inconclusive, with an absence of objective assessments of TSR capacity, and little focus on TSR processes as moderators of intervention effects. CONCLUSIONS: The inconclusive, but reasonably promising, findings point to the value of continuing to apply TSR processes within studies of oral hygiene behavior. Exploring why interdental cleaning appears more reliant on TSR processes than toothbrushing, employing objective neuropsychological assessment, and measuring TSR constructs within interventions targeting TSR processes, are encouraged. As a scoping review, the study hopes to generate interest and serve as a starting point for further investigation.

A person-centred, theory-based, behavioural intervention programme for improved oral hygiene in adolescents: A randomized clinical field study.

AIM: To test the effectiveness of a person-centred and theory-based educational intervention to increase adolescents' adherence to adequate oral hygiene behaviour, that is, self-performed periodontal infection control. MATERIALS AND METHODS: Data were derived from a prospective, multi-centred, two-arm, quasi-randomized field study in which treatment was performed by dental hygienists (DHs) within the Public Dental Service, Västra Götaland, Sweden. Adolescents with poor oral hygiene conditions were invited to participate. The test intervention was based on cognitive behavioural theory and principles, and the DHs used a collaborative communicative approach, inspired by motivational interviewing. The control intervention consisted of conventional information/instruction. Clinical assessments and oral hygiene behaviours were evaluated at 6 months. RESULTS: Three-hundred and twelve adolescents were enrolled, of whom 274 followed the treatment to 6-month follow-up. There were significant improvements in gingival bleeding and plaque scores for both treatment groups at 6 months, with significantly greater improvements in the test group. Adolescents in the test group brushed their teeth and used interdental cleaning aids more frequently compared to participants in the control group at 6 months. CONCLUSION: A person-centred and theory-based oral health education programme is more effective than conventional oral health education in improving adolescents' oral hygiene behaviour and periodontal infection control. CLINICALTRIALS: gov (NCT02906098).

Relationship between dental experiences, oral hygiene education and self-reported oral hygiene behaviour.

Many preventive approaches in dentistry aim to improve oral health through behavioural instruction or intervention concerning oral health behaviour. However, it is still unknown which factors have the highest impact on oral health behaviours, such as toothbrushing or regular dental check-ups. Various external and internal individual factors such as education, experience with dentists or influence by parents could be relevant. Therefore, the present observational study investigated the influence of these factors on self-reported oral heath behaviour. One hundred and seventy participants completed standardized questionnaires about dental anxiety (Dental Anxiety Scale (DAS), and dental self-efficacy perceptions (dSEP)). They also answered newly composed questionnaires on oral hygiene behaviours and attitudes, current and childhood dental experiences as well as parental oral hygiene education and care. Four independent factors, namely attitude towards oral hygiene, attitude towards one's teeth, sense of care and self-inspection of one's teeth were extracted from these questionnaires by rotating factor analysis. The results of the questionnaires were correlated by means of linear regressions. Dental anxiety was related to current negative emotions when visiting a dentist and negative dental-related experiences during childhood. High DAS scores, infantile and current negative experiences showed significant negative correlations with the attitude towards oral hygiene and one's teeth. Dental anxiety and current negative dental experiences reduced participants' dental self-efficacy perceptions as well as the self-inspection of one's teeth. While parental care positively influenced the attitude towards one's teeth, dental self-efficacy perceptions significantly correlated with attitude towards oral hygiene, self-inspection of one's teeth and parental care. Dental anxiety, dental experiences, parents' care for their children's oral hygiene and dental self-efficacy perceptions influence the attitude towards oral hygiene and one's own oral cavity as well as the autonomous control of one's own dental health. Therefore, oral hygiene instruction and the development of patient-centred preventive approaches should consider these factors.

Perception of Pediatric Oncological Patients and Their Parents/Guardians about a Hospital Oral Health Program: A Qualitative Study

BACKGROUND: The oral healthcare offered to pediatric cancer patients at the hospital level must include educational and preventive strategies based on dialogical and welcoming professional attitudes. Therefore, the current study aimed to evaluate the perception of pediatric cancer patients and their parents/guardians about an educational and preventive oral healthcare program implemented in a reference hospital for cancer treatment. METHODS: A qualitative follow-up investigation was conducted in which we evaluated the perception of pediatric cancer patients and their parents/guardians regarding an educational and preventive oral health program (OHEPP). The participants were 27 children and adolescents undergoing cancer treatment and their parents/guardians, and the assessment was carried out at 15 and 30 days after beginning the program through semi-structured interviews. The program used audiovisual resources, storytelling and playful instruments for the oral health education of patients and parents/guardians. The interviews were then transcribed and the Discourse of the Collective Speech (DCS) technique was performed for data analysis. RESULTS: Patients and parents/guardians reported improvement in oral hygiene habits and conditions. Patients reported greater enthusiasm for oral care and highlighted the recreational aspect of the program. Parents/guardians reported being more clear about oral changes and paying attention to the appearance of comorbidities resulting from anticancer treatment. CONCLUSIONS: This study suggests that implementation of the oral health program favored communication between health professionals, patients and their parents/guardians, expanding knowledge and generating behavior change in oral healthcare.

Disparities in Preventive Oral Health Care and Periodontal Health Among Adults With Diabetes.

INTRODUCTION: People with diabetes are more vulnerable to periodontal disease than those without; thus, practicing preventive oral health care is an important part of diabetes self-care. Our objective was to examine disparities in preventive oral health care among US adults with diabetes. METHODS: We performed a secondary analysis of data from the National Health and Nutrition Examination Survey (NHANES) 2011-2016. Periodontal examinations were conducted in adults aged 30 and older. We compared the weighted prevalence of periodontal disease and the practice of preventive oral health care, including practicing dental interproximal cleaning (flossing or using other interproximal cleaning devices) and use of preventive dental services, among people with and without diabetes. Multivariable logistic regressions were performed to examine the relationship between the presence of diabetes, periodontal disease, and preventive oral health care practices. RESULTS: Weighted prevalence of periodontal disease in the US population was higher among adults with diabetes than those without (58.0% vs 37.6%). This difference persisted after controlling for sociodemographic characteristics and smoking status. People with diabetes were more likely to have periodontal disease (adjusted odds ratio [aOR] 1.39; 95% CI, 1.17-1.65), less likely to practice daily interproximal cleaning (aOR 0.85; 95% CI, 0.75-0.95), and less likely to visit a dentist for preventive care in the past year (aOR 0.86; 95% CI, 0.76-0.96) than people without diabetes. CONCLUSION: Adults with diabetes reported suboptimal preventive oral health care behaviors in use of preventive dental services and interproximal dental cleaning than people without diabetes, despite their health disparity related to periodontal disease. Educating people to improve their preventive oral health care is essential for good oral health and diabetes self-management.

Oral hygiene effects verbal and nonverbal displays of confidence.

Although oral hygiene is known to impact self-confidence and self-esteem, little is known about how it influences our interpersonal behavior. Using a wearable, multi-sensor device, we examined differences in consumers' individual and interpersonal confidence after they had or had not brushed their teeth. Students (N = 140) completed nine one-to-one, 3-minute "speed dating" interactions while wearing a device that records verbal, nonverbal, and mimicry behavior. Half of the participants brushed their teeth using Close-Up toothpaste (Unilever) prior to the interactions, whilst the other half abstained from brushing that morning. Compared to those who had not brushed their teeth, participants who had brushed were more verbally confident (i.e., spoke louder, over-talked more), showed less nonverbal nervousness (i.e., fidgeted less), and were more often perceived as being "someone similar to me." These effects were moderated by attractiveness but not by self-esteem or self-monitoring.

[Analysis of sweet snack eating habits and lifestyle using a health check for toddlers].

Objectives　In Japan, medical questionnaires on diet and lifestyle are administered during health checkups for children. Since the rate of health checkup participation is high, the information obtained from these questionnaires can be used for regional diagnoses. In this study, we evaluated the relationship between sweet snack eating habits (SSEHs) and lifestyle habits in toddlers using data from the questionnaires.Methods　This study was conducted across 35 municipalities in Aichi Prefecture, Japan, where individual toddlers can be tracked at medical examinations at the age of 1 year 6 months (18 m) and 3 years (36 m). The subjects were 18,251 toddlers (9,393 boys [51.5%]) who participated in the health checkup in the same municipalities at 18 m in 2013 and 36 m in 2014-2015. Subjects were divided into four categories based on their SSEHs at 18 m and 36 m: N-N (no SSEH at either 18 m or 36 m); Y-N (no SSEH at 36 m only); N-Y (no SSEH at 18 m only); Y-Y (SSEH at both 18 m and 36 m). Other lifestyle habits were divided into two levels: good habits and bad habits. A multinomial logistic regression analysis was performed using the SSEH category as the dependent variable and lifestyle as the independent variable. The control groups were the Y-Y category and bad habit for the dependent and independent variables, respectively.Results　The proportions of N-N, Y-N, N-Y, and Y-Y subjects were 27.7%, 8.6%, 24.1%, and 39.6%, respectively. At 18 m, 48.2% toddlers had an SSEH, which increased to 63.7% at 36 m. Most toddlers (82.2%) had a habit of sweet snacking at 18 m and habitually consumed sweet snacks at 36 m. The absence of nursing at bedtime at 18 m was positively associated with the N-N group (odds ratio [99% confidence interval]=1.25 [1.11-1.41]) and the Y-N group (1.28 [1.07-1.52]); however, no association was found with the N-Y group (0.99 [0.88-1.11]). Parental finish polishing at 18 m tended to show a positive association only with the N-N group (1.10 [0.99-1.23]).Conclusion　Nearly half of toddlers had SSEHs by 18 m, and most of them continued to have the habit at 36 m. Oral hygiene behavior at 18 m was associated with SSEHs of toddlers up to 36 m. A regional diagnosis using the results of the health checkup for children is useful for identifying factors related to health problems.

Predictors of oral health-related quality of life in 2-5 year-old children in the South of Iran.

BACKGROUND: Dental and oral diseases can have negative impacts on children's quality of life. The aim of this study was to determine the predictors of oral health-related quality of life (OHRQoL) in the children aged 2-5 years old. MATERIALS AND METHODS: A total number of 288 children aged between 2 and 5 years were selected and stratified by gender from three community health centres located in the city of Jahrom, south of Fars Province, Iran. The data collection tool was a researcher-made questionnaire whose validity and reliability was confirmed. The questionnaire was completed by parents/caregivers of the children. A multiple linear regression analysis was performed with quality of life as the dependent variable and, based on covariance structural analysis, evaluated the goodness of fit of the resulting structural equations models. RESULTS: The results showed that predisposing factors with a coefficient of 0.0457 (p = 0.015) and reinforcing factors ones with a coefficient of 0.2748 (p < 0.001) were correlated with the oral health behaviours. Moreover, there was a relationship between such behaviours with a coefficient of 0.1612 (p < 0.001) and oral health status and the given status with a coefficient - 0.9714 was correlated with OHRQoL (p < 0.001). Based on the covariance structural analysis, the resulting model was found to exhibit a reasonable goodness of fit. CONCLUSION: The predictors of the children's OHRQoL included predisposing, strengthening, oral health behaviours and oral health status. Therefore, planning to enhance supportive family behaviours and to boost predisposing factors including knowledge, attitudes, perceived benefits, and self-efficacy in parents and their oral health behaviours is recommended.

Improvement in awareness levels and periodontal health among patients undergoing fixed orthodontic appliance therapy with established gingivitis and periodontal health maintenance program: a questionnaire based study / Mejora de los niveles de conciencia y salud periodontal entre pacientes sometidos a terapia con aparatos de ortodoncia fijos con gingivitis establecida y programa de mantenimiento de la salud periodontal: un estudio basado en cuestionarios

Objetive: Home oral care practices in patients undergoing orthodontic therapy are often ineffective in maintaining optimal plaque control. The aim of the present study was to assess the effectiveness of periodontal maintenance program in subjects with established gingivitis undergoing fixed orthodontic appliance therapy for one year. Material and Methods: Forty patients undergoing fixed orthodontic appliance therapy with established chronic gingivitis were recruited for the study. As a part of a periodontal maintenance program, a pre-validated structured questionnaire evaluating oral hygiene and periodontal health was administered at the baseline as well as at the end of the study. At the baseline Gingival Bleeding Index, Gingival Index, and Bonded Bracket Plaque Index scores were recorded, Scaling and polishing procedure was performed followed by a customised Oral Hygiene Advice (OHA) session was conducted for all the study subjects. Clinical indices were assessed and OHA was conducted at the 3rd, 6th, 9th, and 12th months of orthodontic treatment visits. Results: There was significant improvement in the clinical indices and awareness regarding oral hygiene and periodontal health level in the patients at the end of the 12th month. Conclusion: The periodontal maintenance program appeared to be effective in improving the periodontal health and awareness health awareness level about oral hygiene among patients undergoing fixed orthodontic therapy at the end of 12 months in our study population.

Objetivo: Las prácticas de cuidado bucal en el hogar en pacientes sometidos a terapia de ortodoncia suelen ser ineficaces para mantener un control óptimo de la placa. El objetivo del presente estudio fue evaluar la efectividad del programa de mantenimiento periodontal en sujetos con gingivitis establecida sometidos a terapia con aparatos de ortodoncia fijos durante un año. Material y Métodos: Se reclutó para el estudio a 40 pacientes sometidos a terapia con aparatos de ortodoncia fijos y con gingivitis crónica establecida. Como parte de un programa de mantenimiento periodontal, se administró un cuestionario estructurado pre-validado que evaluaba la higiene bucal y la salud periodontal al inicio y al final del estudio. En la línea de base, se registraron las puntuaciones del índice de sangrado gingival, el índice gingival y el índice de placa de soporte adherido, se realizó el procedimiento de raspado y pulido seguido de una sesión personalizada de consejos de higiene oral (CHO) para todos los sujetos del estudio. Se evaluaron los índices clínicos y se llevó a cabo la CHO a los 3, 6, 9 y 12 meses durante las visitas de tratamiento de ortodoncia. Resultados: Hubo una mejora significativa en los índices clínicos y la conciencia sobre la higiene oral y el nivel de salud periodontal en los pacientes al final del 12º mes. Conclusión: El programa de mantenimiento periodontal pareció ser eficaz para mejorar la salud periodontal y el nivel de conciencia de la salud sobre la higiene bucal entre los pacientes sometidos a terapia de ortodoncia fija al final de los 12 meses en nuestra población de estudio.

Oral hygiene practices and utilization of oral healthcare services among in-school adolescents in Calabar, Cross River State, Nigeria.

INTRODUCTION: oral health mirrors an individual´s general health, hence, proper care should be taken to prevent oral diseases and conditions. An estimated 3.9 billion people worldwide are affected by oral conditions, and adolescents are at increased risk due to diet choices and hormonal changes. This study aimed at determining the oral hygiene practices, awareness and utilization of oral healthcare services among in-school adolescents in Calabar Municipality. METHODS: a descriptive cross-sectional study design was employed in studying these variables among in-school adolescents (10-19 years) in secondary schools (JSS1-SSS2) using a self-administered, semi-structured questionnaire. Data were entered and analyzed with EPI-Info. Cross tabulations of variables were conducted using Chi-square test with significance level of 5%. RESULTS: a total of 335 students participated in the study with 228 (68.1%) and 136 (40.6%) reporting that they are aware of and have utilized oral healthcare services (OHS), respectively. There was no statistically significant association between age (p=0.923), gender (p=0.351) and type of school (p=0.497) respectively with awareness and utilization of OHS. Toothache/pain and presumed good dental health respectively were the main reasons for the usage and non-utilization of these services. Time-to-use of oral health services after the onset of toothache/pain was within five days (75.7%). CONCLUSION: the utilization rate of OHS did not match up to the level of awareness of these services with pain being the main driver for utilization. Increased awareness of oral healthcare through health education and oral healthcare demonstrations among adolescents is highly recommended as part of school health programs.

Oral Health of Children with Autism: The Influence of Parental Attitudes and Willingness in Providing Care.

OBJECTIVES: Parents play a crucial role in health-related practices of children with autism spectrum disorder (ASD). This study assessed the association between oral health status and oral health practices of children with ASD in relation to their parental attitudes and comfort in providing oral care. METHODS: This cross-sectional study included 75 children with ASD attending the special needs schools in Eastern Saudi Arabia from 2015-2018. Parents responded to a self-administered questionnaire assessing their attitudes toward oral health and comfort in providing oral care for children. The clinical examination assessed dental caries (decayed, extracted, and filled: (DMF and def)), gingival disease, and plaque accumulation. The Pearson correlation coefficient was used to assess the relationship between the study variables, while ANOVA followed by post hoc was used to assess the differences. RESULTS: Prevalence of dental caries in primary teeth was 76% and 68% in the permanent dentition with a mean of 0.85 ± 1.9 and 1.03 ± 2.9, respectively. Thirty-one participants had gingival problems, mean gingival index was 1.03 ± 0.88, and mean plaque index was 0.95 ± 0.43. Half of the parents supervised their children's brushing, which was significantly associated with plaque accumulation (p = 0.004), gingival disease (p < 0.0001), and def (p = 0.02). Parental attitudes and comfort in providing oral health care were not associated with oral health status of ASD children; however, positive parental attitudes were associated with lower sugar consumption (p = 0.043). An inverse correlation was observed between comfort in providing oral health care with gingival and plaque scores r = -0.18 and -0.23, respectively. CONCLUSIONS: The data are indicative of poor oral health practices and status among ASD children. Parents' oral health care practices seem to be reactive rather than proactive. Positive parental attitudes were associated with lower sugar consumption. Greater comfort in providing care was negatively correlated with plaque accumulation and gingival problems.

[Factors Associated With Oral Health Status and Oral Hygiene Behavior in Patients With Stroke].

BACKGROUND: Studies have shown that oral health is closely related to systemic diseases. Poor oral hygiene may lead to dental caries and periodontal disease and also increase the risk of cardiovascular disease. Patients with stroke have a possibility of recurrence, and good oral health is expected to benefit their general health. Nevertheless, nursing research exploring the oral health and oral hygiene behaviors of stroke patients has been rare. PURPOSE: To explore the factors significantly associated with oral health status and oral hygiene behaviors in patients with stroke. METHODS: A cross-sectional research design with convenient sampling was used. Information on health promoting behaviors and oral health status was collected in a teaching hospital in southern Taiwan. A multivariate linear regression model was applied to explore the factors associated with oral health status in patients with stroke. RESULTS: One hundred and eight-five patients with stroke were enrolled in this study. The average number of real teeth was 11.3 and the average score for oral health status was 4. The univariate analysis showed that being 65 years of age or older, having an education level below primary school, having a lower Barthel index score, having a higher modified Rankin scale score, not brushing and flossing, not having a regular tooth cleaning, having a lower of health promotion score, and having insufficient water intake levels were all associated with a worse oral health status. The stepwise regression analysis showed that factors affecting oral health status include health promotion behaviors, age, tooth brushing, and water intake, which, together, accounted for 28.5% of the total variance. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The findings indicate that oral health status, oral hygiene behaviors, and health promoting behaviors are inadequate among patients with stroke. Clinicians should promote health-related behaviors early to their patients with stroke, specifically in terms of implementing proper oral hygiene behaviors in daily routine care.

Community as the teacher on issues of social responsibility, substance use, and queer health in dental education.

INTRODUCTION: In order to foster dental and dental hygiene practices that are inclusive, sensitive to diversity, equitable, and without prejudice, a call to broadly teach cultural diversity within dental and dental hygiene education has been made. The research question of this study was "to what extent can an interactive and open dialogue about substance use, queer health, and social responsibility foster transformative learning?" METHODS: A collaborative and interdisciplinary project engaged the community as a teacher over the Summer and Fall of 2019 to address issues of substance use, queer health, and social responsibility and was delivered to 55 first-year undergraduate dental and 23 third-year dental hygiene students over three educational sessions. Dental and dental hygiene students were asked to reflect, in writing, on each session using between 200 and 400 words. Textual information from students' self-reflections and from the community's feedback were analyzed thematically for content (e.g., codes and themes). RESULTS: In total, 128 written reflections-for an average of 42 reflections per session-were gathered and analyzed interactively by the authors. Three major themes emerged: feeling privileged, breaking stereotypes, and coalescing learning. Feedback from the participating community members highlighted changes to be implemented in these sessions in the future, including more opportunities for small group activities in class. CONCLUSIONS: The three major themes that emerged from the thematic analysis of the self-reflections and community member feedback (feeling privileged, breaking stereotypes, and coalescing leaning) further highlighted the impact of community-driven curricula on students' learning in regard to substance use, queer health, and social responsibility. Further work is critical to understand the impact of such a pedagogy on students' practices once they leave their undergraduate programs.

The Effects of Gamification and Oral Self-Care on Oral Hygiene in Children: Systematic Search in App Stores and Evaluation of Apps.

BACKGROUND: Poor oral hygiene is a great public health problem worldwide. Oral health care education is a public health priority as the maintenance of oral hygiene is integral to overall health. Maintaining optimal oral hygiene among children is challenging and can be supported by using relevant motivational approaches. OBJECTIVE: The primary aim of this study was to identify mobile smartphone apps that include gamification features focused on motivating children to learn, perform, and maintain optimal oral hygiene. METHODS: We searched six online app stores using four search terms ("oral hygiene game," "oral hygiene gamification," "oral hygiene brush game," and "oral hygiene brush gamification"). We identified gamification features, identified whether apps were consistent with evidence-based dentistry, performed a quality appraisal with the Mobile App Rating Scale user version (uMARS), and quantified behavior scores (Behavior Change score, uMARS score, and Coventry, Aberdeen, and London-Refined [CALO-RE] score) using three different instruments that measure behavior change. RESULTS: Of 612 potentially relevant apps included in the analysis, 17 met the inclusion criteria. On average, apps included 6.87 (SD 4.18) out of 31 possible gamification features. The most frequently used gamification features were time pressure (16/17, 94%), virtual characters (14/17, 82%), and fantasy (13/17, 76%). The most common oral hygiene evidence-based recommendation was brushing time (2-3 minutes), which was identified in 94% (16/17) of apps. The overall mean uMARS score for app quality was high (4.30, SD 0.36), with good mean subjective quality (3.79, SD 0.71) and perceived impact (3.58, SD 0.44). Sufficient behavior change techniques based on three taxonomies were detected in each app. CONCLUSIONS: The majority of the analyzed oral hygiene apps included gamification features and behavior change techniques to perform and maintain oral hygiene in children. Overall, the apps contained some educational content consistent with evidence-based dentistry and high-quality background for oral self-care in children; however, there is scope for improvement.

Association between adverse childhood experiences, bullying, self-esteem, resilience, social support, caries and oral hygiene in children and adolescents in sub-urban Nigeria.

BACKGROUND: Adverse childhood experiences (ACE) and bullying have negative effects on oral health. Promotive assets (resilience, self-esteem) and resources (perceived social support) can ameliorate their negative impact. The aim of this study was to determine the association between oral diseases (caries, caries complications and poor oral hygiene), ACE and bully victimization and the effect of access to promotive assets and resources on oral diseases. METHODS: This was a secondary analysis of data collected through a cross-sectional school survey of children 6-16-years-old in Ile-Ife, Nigeria from October to December 2019. The outcome variables were caries, measured with the dmft/DMFT index; caries complications measured with the pufa/PUFA index; and poor oral hygiene measured with the oral hygiene index-simplified. The explanatory variables were ACE, bully victimization, resilience, self-esteem, and social support. Confounders were age, sex, and socioeconomic status. Association between the explanatory and outcome variables was determined with logistic regression. RESULTS: Of the 1001 pupils with complete data, 81 (8.1%) had poor oral hygiene, 59 (5.9%) had caries and 6 (10.2%) of those with caries had complications. Also, 679 (67.8%) pupils had one or more ACE and 619 (62.1%) pupils had been bullied one or more times. The median (interquartile range [IQR]) for ACE was 1(3), for bully victimization was 1(5), and for self-esteem and social support scores were 22(5) and 64(34) respectively. The mean (standard deviation) score for resilience was 31(9). The two factors that were significantly associated with the presence of caries were self-esteem (AOR: 0.91; 95% CI: 0.85-0.98; p = 0.02) and social support (AOR: 0.98; 95% CI: 0.97-1,00; p = 0.02). No psychosocial factor was significantly associated with caries complications. Self-esteem was associated with poor oral hygiene (AOR: 1.09; 95% CI: 1.09-1.17; p = 0.03). CONCLUSION: There was a complex relationship between ACE, bully victimization, access to promotive assets and resources by children and adolescents, and oral health. ACE and bully victimization were not associated with oral health problems. Though self-esteem was associated with caries and poor oral hygiene, the relationships were inverse. Promotive assets and resources were not associated with caries complications though resources were associated with lower prevalence of caries.

Are parents' education levels associated with either their oral health knowledge or their children's oral health behaviors? A survey of 8446 families in Wuhan.

BACKGROUND: Children aged 6-7 years are in the early mixed dentition, which is a period of high prevalence of dental caries and other dental diseases and a critical period for the formation of oral health behaviors. Therefore, good oral hygiene habits of children and oral health knowledge of parents are very important. This study sought to explore the relationship between children's oral health behaviors, parental oral health knowledge, parental choices of pit and fissure sealants, and parents' education levels based on a large-scale sample size for the first time, and to compare the influences of parental education levels between parents. METHODS: Families of the first and second graders of primary schools in Wuhan Hongshan District were included in this study. A total of 8446 questionnaires were collected to obtain comprehensive information on children's oral health behaviors, parents' oral health knowledge and parents' pit and fissure sealants-related choices. The relationship between these outcome variables and parents' education levels were studied using logistic regression analysis and chi-square test. RESULTS: Parents who reported good educational background had more favorable oral health knowledge than those of other parents, and their children had better oral hygiene behaviors. Four indicators of five measures to children's oral health behaviors were significantly associated with mother's education level (P < 0.05), and three of them were related to father's education level (P ≤ 0.01). Moreover, seven indicators of eight measures to parents' oral health knowledge were significantly related to mother's education level (P < 0.05) and four of them were affected by the father's (P < 0.05). In addition, parents with higher educational attainments paid more attention to the completeness of medical facilities, the environment of dental practice, the distance to treatment sites, and took less concern of children's willingness when choosing the pit and fissure sealants sites. CONCLUSIONS: In families with children at the early mixed dentition stage, parents with higher education levels tend to have better oral health knowledge and more oral health care needs, such as pit and fissure sealants. In addition, children of parents who have better educated parents tend to perform better oral hygiene practices.