Correlates of dental visits in children with hearing loss: An application of the theory of planned behaviour.

BACKGROUND: Maintenance of oral health of children with special needs requires the involvement of caregivers who are also responsible for ensuring adherence to professional recommendations, including dental visits. AIM: This study aimed at exploring the correlates of dental visits of children with hearing loss (CWHL) in Indonesia using the theory of planned behaviour (TPB). DESIGN: This cross-sectional study involved purposive sampling methods, conducted via an online survey administered to mothers of CWHL who were aged 5-12 years. Constructs of the TPB model were collected, including the mother's attitudes, subjective norms, perceived behaviour control (PBC) and intention towards dental visits for CWHL. Dental visits were measured by asking whether their children had a dental visit within the last 12 months. Data were analysed using SPSS for descriptive and bivariate analyses. The significance level was set as p < .05. Partial least square structural equation modelling (PLS-SEM) was used to analyse measurement and structural TPB models. RESULTS: A total of 254 mothers participated in this study. The final TPB model explained 35.4% and 9.2% of the variance in mothers' intention and behaviour towards their children's dental visits, respectively. Of all the included constructs from the TPB model, only PBC was significantly associated with intention and behaviour (p < .05). The mother's attitude and subjective norms did not significantly predict intention (p > .05). Intention did not significantly predict the mother's behaviour towards children's dental visits (p > .05). CONCLUSION: The TPB model revealed a construct associated with dental visit intention and behaviour in CWHL. This study suggested that effective promotion intervention should focus on the mother's PBC to increase parents' adherence to preventive dental visits in CWHL in Indonesia.

Validity of mother-child self-perceived oral health for the assessment of 5 years old children's oral health in Indonesia.

BACKGROUND: Early childhood caries (ECC) is a serious condition that has a negative impact on young children's quality of life. Mothers' perceived need for oral health care plays an important role in their children's oral health behavior. This study aimed to compare mother and child self-perceived and dentist-evaluated needs for oral health care. METHODS: This cross-sectional study included 266 preschool children aged 5 years old and their mothers. A self-administered questionnaire to the mothers and interviews with the children were used to assess the perceived needs of oral health care. The mothers were asked to rate their children's oral health and determine if they needed dental treatment. The children were also asked how they felt about their oral health and whether they had any tooth decay. Agreement between mother and child regarding the child's oral health was assessed. The evaluated needs were assessed clinically using the dmft (decayed, missing, and filled teeth [primary dentition]) and pufa (pulpal involvement, ulceration, fistula, and abscess [primary dentition]) indices. The perceived and evaluated needs were compared using spearman analysis to determine their correlations and the validity of the perceived needs compared to the clinical examination was assessed using the area under the curve (AUC), sensitivity (Sn), specificity (Sp), and likelihood ratio (LR). RESULTS: The prevalence rate of ECC was 89.4%, with 35% having at least one condition from untreated caries (pufa > 0). Mothers and children have a fair agreement regarding the child's oral health (ICC = 0.335). When comparisons were conducted between perceived and evaluated conditions, Mother's rating about their child's oral health showed the strongest correlation to dmft index (r = 0.372; p < 0.001). Several accuracy parameters done in this study (AUC, Sn, and Sp) did not meet the acceptable threshold. The sensitivity and specificity were the highest when comparing mothers' perceived need for their child's dental treatment to the dmft index (Sn = 96.7%) and pufa index (Sp = 88.1%), respectively. CONCLUSION: Compared to the dentist's assessment, the mother and child self-reported oral health statuses showed lower accuracy in assessing the child's condition. But, the mothers in this study were better than their 5-year-old children at perceiving their child's oral health care needs. As a result, these subjective assessments can be used as a complement, but not as a substitute, to the actual clinical evaluation.

Application of the extended theory of planned behavior to predict dentist intention and behavior in providing caries preventive care for preschool children.

BACKGROUND: Various studies show a gap between evidence-based recommendations and the preventive practice of dentists. This study aimed to create and assess an extended Theory of Planned Behavior (TPB) model on dentists' intentions to do caries preventive measures and related barriers experienced by dentists. METHODS: A total of 362 general dentists from 34 Indonesian provinces were included in this study. A self-administered online questionnaire consisted of three sections: dentist characteristics and practice pattern, TPB questionnaire, and dentist perceived behavior regarding preventive care for pediatric patients. The questionnaire was distributed and the data was analyzed through structural equation modeling. RESULTS: TPB's extended version is a fit and relevant model, explaining 55.3% of dentists' intentions to undertake preventive procedures and 17.8% of preventive practices. Perceived behavioral control was the most powerful predictor of intention (44.2%) and practice (8.8%), while parental barriers were the most significant barrier to provide preventive care (18.9%). CONCLUSION: Extending the TPB by taking barriers from multiple stakeholders as a consideration has a higher predictive level for preventive practices. Each barrier should be addressed through oral health programs and policies, and dentists must be taught to overcome these barriers (through formal or continuing education) in order to maximize caries prevention strategies.

Effectiveness of web application as educational media in increasing the caries risk knowledge and decreasing the caries risk score among dental students in Indonesia.

BACKGROUND: This study evaluating the effect of web application media in increasing the caries risk knowledge and decreasing the caries risk scores among dental students. METHODS: A quasi-experimental design along with a purposive sampling technique was used in this study. A total of 361 undergraduate pre-clinical dental students from 15 universities in Indonesia were divided into two groups: intervention (n = 282) and control (n = 79). The students in the intervention group received a web application media with educational materials to independently check their caries risk, whereas those in the control group received the application without any educational materials. The students were instructed to use the web application at least once a week for 21 days and complete the pretest and posttest questionnaires and web application evaluation questionnaires. In addition, they were required to independently examine their initial and final caries risk. RESULTS: A significant increase in the level of knowledge was observed in the intervention group, but not in the control group, after the use of the web application. Each group showed a decrease in the caries risk score, but the difference was not statistically significant before and after the use of a web application in both groups. CONCLUSION: These findings indicate that health promotion and education about caries risk through web application media can improve the knowledge and reduce the caries risk in dental dentistry students.

Intention to provide tobacco cessation counseling among Indonesian dental students and association with the theory of planned behavior.

BACKGROUND: Use of tobacco is a serious public health problem in Indonesia that requires a multidisciplinary approach by healthcare providers to address it. The study assessed the intentions of undergraduate students in dental schools to provide tobacco cessation counseling (TCC) and their association with the constructs of the theory of planned behavior (TPB). METHODS: A cross sectional study was conducted in October 2019 using an electronic survey for dental students in Indonesian dental schools (n = 30). The survey assessed schools and students' characteristics and eleven statements assessed their perspectives toward TCC based on the TPB using a 5-point Likert scale. Principal component analysis (PCA) was used to identify components within the items of perspective. Multilevel linear regression analysis was used to assess the association between intention to provide TCC and the constructs of the TPB as identified in the perspectives' items using TPB controlling for confounders. RESULTS: About 1288 students participated from 30 dental schools, 83.3% females with mean age = 21.5 years with average intention to provide TCC = 4.3 out of 5. They had above average positive attitude about provision of TCC being the dentist's role (mean = 3.8 out of 5). PCA identified two components: confidence in their own abilities and perception of favorable environment with average scores = 3.2 and 2.7 out of 5. Intention to provide TCC was significantly associated with more positive attitude recognizing TCC as a dentist's role (B = 0.10, P < 0.0001), greater confidence in skills to provide TCC (B = 0.17, P < 0.0001) and less perception of favorable environment supportive off providing TCC (B = - 0.20, P < 0.0001). CONCLUSIONS: Indonesian dental students' intention to provide TCC can be explained by the constructs of the TPB. Development of dental curricula promoting professional responsibility toward TCC should be given attention. Improving students' attitude and confidence potentially may support their patients' efforts to quit smoking.

Tooth wear among five-year-old children in Jakarta, Indonesia.

BACKGROUND: This study aimed to evaluate the prevalence of tooth wear among preschool children in Jakarta, Indonesia, and examine the risk factors associated with its occurrence. METHODS: An epidemiological survey was conducted with a cross-sectional study design. The participants were recruited via cluster sampling. Tooth wear was clinically assessed by one examiner using the Basic Erosive Wear Examination (BEWE) criteria. The children's caries experience was also recorded. The parents of the participating children completed a self-administered questionnaire to answer demographic questions about the children and gather information about the children's diet and oral health behaviors as well as the parents' dental health-related knowledge. The data were analyzed using the Chi-square test and binary logistic regression. RESULTS: A total of 752 five-year-old children were invited to participate, with 691 (92%) enrolling in the study. Tooth wear occurred in 23% (161/691, BEWE > 0) of the participants, in which 78% (125/161) had at least one moderate tooth wear status (BEWE = 2). The consumption of citrus drinks, fruit juice, and vitamin C supplement drinks, together with the child's caries experience, the father's education level, and the family's socioeconomic status, were significantly associated with tooth wear. CONCLUSIONS: The five-year-old preschool children in Jakarta had a relatively low prevalence of tooth wear. Those consuming more acidic drinks, those with a higher socioeconomic status, and those with an absence of caries experience had a higher risk of tooth wear.

Perception of Special-Care Dentistry among Dental Students at Universitas Indonesia: A Cross-Sectional Study.

OBJECTIVE: To assess the perceptions of special-care dentistry (SCD) among dental students in the Faculty of Dentistry, Universitas Indonesia, Indonesia. METHODS: This cross-sectional study used a self-administered online questionnaire, and all preclinical and clinical students were invited to participate. The survey items comprised four domains related to participants' characteristics, perceptions of SCD, perceptions of managing patients with special needs, and perceptions of SCD education. The chi-square test and Mann-Whitney test were used in the analysis. RESULTS: A total of 572 students participated in this study. The findings showed that the clinical students were more familiar with SCD than the preclinical students were (p = 0.008). A statistically significant relationship was found between the study program and the ability to work independently with special-needs patients after graduation (p < 0.001), the ability to refer special-needs patients to specialists (p = 0.042), the perception of postgraduate training-program needs (p < 0.001), and the opportunity to consider postgraduate training (p = 0.004). CONCLUSION: Most of the respondents had a favorable perception of SCD. Thus, an improved SCD curriculum and SCD training for undergraduate and postgraduate students should be provided to develop the knowledge and skills needed to provide care to special-needs patients.

Perceived Barriers among Indonesian General Dentists in Providing Caries Preventive Care for Pediatric Patients.

OBJECTIVE: This study aimed to investigate Indonesian dentists' perceived barriers in providing caries prevention for pediatric patients. MATERIALS AND METHODS: A total of 362 general dentists were included in this cross-sectional study. The participants were asked to complete a self-administered online questionnaire of dentist characteristics and perceived barriers in multiple domains (children, parents, dentists, and healthcare system-related barriers). The frequency of responses to items of the questionnaire was presented. The Mann-Whitney U test was used to compare perceived barriers by gender, Kruskal-Wallis by practice sector, and Spearman analysis was used to assess the correlation between perceived barrier with age, years of practice experience, weekly practice hours, percentage of pediatric patients, percentage of pediatric preventive care, and percentage of insured patients. A multivariate analysis was conducted through structural equation modeling. RESULTS: The highest perceived barrier was found to be healthcare system-related, followed by parents, children, and dentists themselves. Most participants thought parents have poor knowledge of pediatric caries prevention (n = 290; 80%), and dental care for young children emphasizes curative treatment over prevention (n = 257; 70%). The multivariate analysis showed that dentists' practice sector and age affect perceived barriers and pediatric preventive care the most. CONCLUSIONS: Factors and barriers identified in this study must be the main focus of oral health programs, and dentists, as service providers, need proper training to address these barriers to optimize caries prevention in Indonesia.

Cross-cultural adaptation and psychometric properties of the Indonesian version of theory of planned behavior questionnaire to measure dental attendance of children with hearing loss: A pilot study.

AIMS: To translate and evaluate the validity and reliability of the Indonesian version of the Theory of Planned Behavior (TPB) questionnaire concerning mother's behavior related to children's dental attendance. METHODS AND RESULTS: The cross-cultural adaptation was tested in mothers with children aged 5-12 years old who have hearing loss. The validity and reliability of the online questionnaire were measured among 31 mothers of children with hearing loss in communities and Special School for Children with Hearing Loss in several regions in Indonesia. All indicators of attitude, subjective norms, and perceived behavior control (PBC) on mothers' behavior towards children's attendance was valid (p < .05). The overall Cronbach's alpha of the questionnaire for internal consistency was 0.773. The test-retest reliability results were based on repeated administration in the same participant mother, measured at one-week interval; the interclass correlation coefficient (ICC) was 0.903. CONCLUSION: The Indonesian version of the TPB questionnaire concerning mother's behavior related to children's oral health has shown adequate validity and reliability for investigating the dental attendance of children with hearing loss.

The Relationships Among Oral Health Practices, Early Childhood Caries, and Oral Health-related Quality of Life in Indonesian Preschool Children: A Cross-Sectional Study.

OBJECTIVES: This study aimed at evaluating the relationships among oral health practices, early childhood caries (ECC), and oral health-related quality of life (OHRQoL) in five-year-old children in Indonesia. MATERIALS AND METHODS: Overall, 266 parent-child pairs (PCPs) from preschools in Jakarta participated in a cross-sectional study. The ECC was clinically assessed by two calibrated screeners using the decayed, missing, and filled teeth (dmft) and the pufa index, which records the presence of severely decayed teeth with visible pulpal involvement (p), ulceration caused by dislocated tooth fragments (u), fistula (f), and abscess (a). The parents of the participating children completed the self-administered questionnaire comprising SOHO-5p and their oral health practices. The SOHO-5c questionnaire was used to interview the children. RESULTS: The prevalence of ECC was 88.7%, with 35% having pufa index scores greater than 0. There were significant relationships among oral health practices, ECC, and the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5) scores. There was also a significant relationship between cariogenic food consumption and the dmft and SOHO-5p scores. There was a significant relationship between ECC and the SOHO-5 scores. All the SOHO-5p variables except smile avoidance because of appearance had a significant relationship with the dmft and pufa variables. Eating and sleeping difficulties were significantly related to the dmft and pufa scores. CONCLUSION: OHRQoL was found to be related to the dmft and pufa scores, and the parents' perceptions were more strongly correlated than the children's. No significant difference was found in the perceptions indicated by the SOHO-5p and SOHO-5c scores. This suggests that parents can be used as proxies regarding their children's OHRQoL.

Knowledge, Attitudes, and Practices Regarding Teledentistry Among Dentists in Jakarta During the Coronavirus Disease (Covid-19) Pandemic: A Cross-Sectional Study

Abstract Objective: To assess factors associated with knowledge, attitudes, and practices (RAP) related to teledentistry among dentists in Jakarta during the COVID-19 pandemic. Material and Methods: This cross-sectional study used a self-administered online questionnaire with a purposive sampling technique. Survey items comprised knowledge of, attitude toward, the practice of, and barriers to teledentistry. The Chi-square, Mann-Whitney, and Spearman correlation tests were used to determine factors associated with RAP of teledentistry. Results: A total of 183 dentists in Jakarta completed the questionnaire. The findings showed that 95.6% of the surveyed dentists had good knowledge, 83.1% expressed positive attitudes, and 60.7% practiced teledentistry during the COVID-19 pandemic. Most participants (86.3%) expressed a willingness to practice teledentistry in the future. The three most significant barriers that obstruct dentists from practicing teledentistry are patient compliance and satisfaction regarding the dentist's physical presence, a low population education level, and a lack of technological infrastructure. A statistically significant relationship was found between teledentistry practice and age, marital status, working experience, and training regarding teledentistry. A positive correlation was found between knowledge of and attitude toward teledentistry. Conclusion: Dentists in Jakarta have a high understanding of, positive attitudes toward, and good practices for teledentistry. Factors related to teledentistry practice were age, marital status, work experience, and training experience in the last two years.

Validity of Self-perceived and Clinically Diagnosed Gingival Status among 12-15-year-old Children in Indonesia.

A few studies have revealed the self-perceived gingival status using questionnaires among children. Perceived health is a crucial factor that has an impact on quality of life. The objective of the study was to assess self-perceived and clinically diagnosed gingival status among children in Indonesia. This was a cross-sectional study of 494 schoolchildren (aged 12-15 years). Periodontal status was recorded using the gingival index (GI) and plaque index (PI) based on the World Health Organization standards. Data were collected through a brief visual, non-invasive clinical oral examination and a self-administered questionnaire. The sensitivity and specificity of self-perceived assessment were calculated using normative assessment as the gold standard. This study showed that self-perceived need for dental treatment showed the highest sensitivity (86% using PI and 85% using GI) and self-perceived swollen gums showed the highest specificity (89% using PI and 88% using GI) for clinically diagnosed plaque (PI cut-off value: 0.74) and gingival problems (GI cut-off value: 0.51). In conclusion, both self-perceived variables showed significant discordance between their respective sensitivity and specificity. Self-perceived information is at a higher-level unawareness that does not reflect the current gingival status. Thus, public health strategies are needed to improve the awareness of better oral health among children by promoting, empowering, and advocating.

Effectiveness of Dental Health Education Intervention Using the 16-Surface Tooth Brushing Program Among 7-9-Year-Old Schoolchildren in Indonesia

Abstract Objective: To determine the effect of dental health education for teachers and parents on children aged 7-9 years old. Material and Methods: This was a quasi-experimental study with a nonrandomized control group and a pretest-posttest design. The intervention group comprised 20 teachers and 66 mothers, whereas the control group consisted of 10 teachers and 54 mothers. Data on the knowledge and behavior of teachers and mothers were retrieved by pretest and posttest questionnaires. The 66 children in the intervention group underwent a 16-surface tooth brushing program, whereas the 54 children in the control group were only provided theoretical education by their teachers and mothers. The evaluation was conducted after one month to measure the children's dental plaque index. Results: An increase in teachers' oral health knowledge (16.7%), teachers' oral health behavior (20%), mothers' oral health knowledge (16.7%), and mothers' oral health behavior (20%) was noted; the children's plaque index was decreased (47%). Conclusion: The dental health education of teachers and parents (mothers) supported by the 16-surface teeth brushing program resulted in a significant reduction in the dental plaque index in children aged 7-9 years old.

Association Between Early Childhood Caries and Feeding Pattern in 3- to 5-Year-Old Children in Grogol Utara, South Jakarta

Abstract Objective: To evaluate the relationship between the feeding method and early childhood caries (ECC) in children aged 3-5 years. Material and Methods: An observational study using a cross-sectional approach and convenience sampling method was performed on 165 children aged 36-71 months from eight kindergartens in Grogol Utara, Indonesia. Data on feeding and oral hygiene behavior patterns were obtained through interviews using a structured questionnaire, and an oral examination was performed to collect information on oral health using the decayed, extracted, filled surface and plaque indices. The oral examination was performed by two examiners who were calibrated for intra- and interobserver reliability (Kappa = 0.9) Results: The prevalence of dental caries was 83%, with mean values of decayed, extracted, filled teeth (deft) and of defs being 6.2 and 14.8, respectively. The prevalence of children with anterior dental caries was higher than that of children with posterior-only dental caries. The most severely affected teeth were maxillary central incisors (right = 62.4%; left = 61.2%), followed by maxillary lateral incisors (right = 49.1%; left = 44.2%). The caries pattern was almost symmetrical across the arches. There were significant differences between breastfeeding methods with anterior (p<0.05), but not with posterior dental caries. The complementary feeding initiation age was significantly different between anterior and posterior teeth caries groups (p<0.05), but complementary food type after tooth eruption and infant formula frequency were related only to anterior dental caries (p<0.05) Conclusion: The patterns of breastfeeding and complementary feeding were related to dental caries in anterior and posterior teeth. The feeding method that increases the ECC score in anterior and posterior teeth was the age at initiation of complementary feeding.