Changes in the Utilization of Outpatient and Visiting Dental Care and Per-attendance Care Cost by Age Groups During COVID-19 Pandemic Waves in Japan: A Time-series Analysis From the LIFE Study.

BACKGROUND: The influence of the coronavirus disease 2019 (COVID-19) pandemic on dental care utilization may have differed according to individual characteristics or type of dental care provision. This study aimed to evaluate the changes in dental care utilization and per-attendance costs by age group and type of dental care during the COVID-19 pandemic in Japan. METHODS: This time-series study used healthcare insurance claims data from 01/07/2019 to 09/27/2021 (143 weeks) from nine municipalities in Japan. Dental care utilization rate per week and average dental care cost per attendance by age groups (0-19 years/20-64 years/65-74 years/≥75 years) and types of dental care (outpatient/visiting) were used as outcome variables. COVID-19 pandemic waves in Japan were used as predictors: 1st (03/23/2020-05/17/2020), 2nd (06/22/2020-09/27/2020), 3rd (10/26/2020-02/21/2021), 4th (02/22/2021-06/07/2021), and 5th (07/05/2021-09/13/2021) waves. Fixed-effects models were employed to estimate the proportional changes. RESULTS: In the fixed-effects model, we observed large declines in dental care utilization during the 1st (17.0-22.0%) and 2nd waves (3.0-13.0%) compared to the non-pandemic wave period in all age groups. In contrast, the average dental care cost per attendance increased in all age groups by 5.2-8.6% during the 1st wave. CONCLUSION: During the initial wave of the COVID-19 pandemic in Japan, dental care utilization decreased in all age groups, whereas the average dental care cost per attendance increased. The COVID-19 pandemic may have changed the dental care provision pattern towards less frequent and more concentrated dental care to avoid the risk of infection.

Barriers and Facilitators to Dental Care Services Utilization Among Children With Disabilities: A Systematic Review and Thematic Synthesis.

BACKGROUND: This systematic review investigates barriers and enablers to dental care utilization by disabled children. Given the high global prevalence of disabilities in children, coupled with poor oral hygiene and a 45% rate of dental caries in this group, developing inclusive oral health strategies is critical. The review aims to synthesize literature on factors affecting oral healthcare improvement for disabled children, identifying barriers, facilitators and knowledge gaps. METHODS: The review was conducted following the Joanna Briggs Institute's methods and reported according to PRISMA guidelines. A comprehensive search spanned multiple databases, considering perspectives from carers, parents, dentists and health professionals. The focus was on studies involving children up to age 17 with disabilities, as defined by WHO, using dental care services. Exclusions included non-qualitative studies, populations over 18 and nondisabled children. There were no restrictions on publication date or language. Thematic synthesis of the studies extracted themes related to barriers and enablers in oral healthcare for disabled children. RESULTS: Thematic synthesis identified five overarching themes: stigma, communication issues, professional development, oral health education and medical-dental collaboration. Facilitators included enhancing accessibility and availability of dental care through a holistic approach, improving dental care facility environments and ensuring skilled dental care providers. DISCUSSION: The review underscores the importance of interprofessional collaboration, improved parent/caregiver education and specialized dental facilities to support children with disabilities. It identifies key barriers and facilitators in dental care, including challenging stereotypes, improving communication between providers and parents, enhancing holistic training and addressing gaps in oral health education and integrated healthcare systems. CONCLUSION: Addressing the complex dynamics of dental care for disabled children is essential for developing inclusive and effective preventive and therapeutic strategies. This review highlights the need for tailored approaches and enhanced support systems to improve oral health outcomes in this vulnerable population. PATIENT AND PUBLIC CONTRIBUTION: The members of the family support department, Middle East and North Africa (MENA) Organization for Rare Disease and Disability who provided the disability voice and contributed to providing input to the review protocol.

'The Letter Says I May or May Not Be Eligible It Is a Big Doubt and Frustrating:' A Qualitative Study on Barriers and Facilitators to Children's Oral Healthcare From the Perspective of Karen Refugee Parents in Victoria.

BACKGROUND: Australia has a longstanding tradition of resettling refugees and individuals in humanitarian need. Among these, the Karen community from Southeast Asia is rapidly growing in Australia. The absence of data on the barriers they face in accessing dental services is concerning. This study explores the barriers and facilitators Karen refugees encounter when seeking oral healthcare for their children in Australia, aiming to understand their experiences. METHODS: Using a qualitative research design with a phenomenological approach, we conducted semi-structured interviews with 23 parents (17 females and 6 males) who had been in Australia for 1-17 years. Each interview, lasting between 35 and 60 min, was audio-recorded and transcribed verbatim. The transcripts were thematically analysed through an inductive, data-driven approach, focusing on open coding and participant-based meanings. FINDINGS: Nine main themes were identified. At the individual level, cultural practices, parental behaviours and perceptions were the primary barriers. At the organisational level, long waiting lists in the public dental system were significant barriers. Additionally, a lack of knowledge about financial benefits and government support for children's dental care deterred refugees from seeking dental services. The results also highlighted the strengths of support networks, free dental care for children and school-based dental care programmes. Parents reported experiences of inadequate oral healthcare, citing issues such as insufficient cultural sensitivity training among dental service providers, interpreter problems and shortages. These experiences revealed gaps in the provision of oral healthcare services. CONCLUSION: When designing tailored oral health promotion programs, all stakeholders must consider the lived experiences of refugees as valuable sources of information. PATIENT OR PUBLIC CONTRIBUTION: The authors thank the parents and carers from the Karen refugee community for sharing their experiences with the oral healthcare of their children. Recruitment was facilitated by the Karen Organisation of Bendigo and Bendigo Community Health Services. An interpreter from the Karen refugee community assisted in all the interviews.

Parent's acceptance of advanced behavior management techniques on children during dental treatment.

AIM: This study explores the acceptance of Advanced Behavior Management Techniques (ABMTs) by parents during their children's dental treatments, comparing the opinion of parents of neurotypical children with that of parents of children with autism spectrum disorders (ASDs). METHODS: An observational cross-sectional study was conducted involving 440 parents, divided into two groups: 236 parents of neurotypical children and 204 parents of children with ASDs, recruited from pediatricians' centers and centers for ASDs children in Northern and Southern Italy. A survey assessed their familiarity and acceptance of ABMTs, including protective stabilization, conscious sedation, and deep sedation/general anesthesia. Discrete variables were expressed as absolute and relative frequencies (%) and compared with Pearson's chi-squared or Fisher's exact test. Continue variables were expressed as mean ± SD and compared with the one-way ANOVA test. Heatmap and PCA analysis were used to determine possible correlations between items. RESULTS: Parents of children with ASDs showed a higher acceptance rate of ABMTs compared to parents of neurotypical children. Overall, only 30.68% of parents knew ABMTs before the survey. Differences between the two groups of parents in acceptance of Active Stabilization in emergency settings, Passive Stabilization in routine settings, and Deep sedation/general anesthesia in both settings were observed (p < 0.01). Only 6.82% of parents ever used at least one ABMT on their children. Heatmap analysis revealed that parents who have accepted one of the ABMTs tend to accept the others as well. CONCLUSION: Differences in parental acceptance of different ABMTs was noted among the two groups of parents, with greater acceptance of ABMTs observed in the group of parents of children with ASDs. Parents of both groups have significant gaps in their knowledge of ABMTs. Therefore, increased awareness and personalized communication strategies are needed to increase acceptance of the studied techniques and, thus, facilitate access to dental care for uncooperative pediatric patients. Patient-centered behavior management strategies that meet children's needs and parents' preferences can contribute to the achievement of good oral health.

Medicaid Dental Benefits for Pregnant People and Dental Care Use Among Very Young Children.

OBJECTIVES: The aim of this study was to examine the association between Medicaid dental benefits for pregnant people and dental care use among very young children in Medicaid. We hypothesized that children living in states with more generous dental benefits for Medicaid-enrolled pregnant people would be more likely to have a recent dental visit. METHODS: This national cross-sectional study used pooled 2017-2019 data from the National Survey of Children's Health, as well as state Medicaid policy data. The study sample included children aged 0-2 enrolled in Medicaid. Multivariable logistic regression models estimated the association between Medicaid dental benefit generosity for pregnant people and the child having a dental visit in the past year. RESULTS: Children in states with emergency-only dental coverage for pregnant people were 2.5 times as likely to have had a dental visit than children in states with extensive coverage (OR 2.48, 95% CI 1.35-4.53). In supplemental analyses excluding children living in Texas, there was no longer an association between dental coverage for pregnant people and dental utilization among young children (OR 1.52, 95% CI 0.82-2.83). CONCLUSIONS FOR PRACTICE: Young children in states that provided emergency-only dental benefits for pregnant people in Medicaid had significantly higher odds of dental utilization than young children in states with more generous dental benefits for pregnant people. This relationship disappeared after excluding the state Texas, which had the highest rate of child dental utilization in the country and provided emergency-only dental benefits for pregnant people in Medicaid.

Children's experiences during their first dental visit: A qualitative study.

BACKGROUND: While the child's first dental visit can shape his/her attitude towards further treatments, little consideration has been given to exploring this experience from the child's perspective. Therefore, the aim of the study was to delineate the experiences of the first dental visit of children based on self-written stories in their own words. METHODS: Qualitative study conducted as part of the oral health promoting school program in Isfahan city, Iran. Data collection was based on the responses to a question included in the programme's printed educational content. Schoolchildren were asked to explain about their experiences of their first dental visit in a story. Two researchers read the stories separately and identified concepts and themes. In a discussion panel gained consensus about the main themes. Then the researchers integrated and grouped together similar themes to new categories. Categories originating in the data provided insights into and explanations of factors that might influence the schoolchildren's experience in the dental office. Sampling continued until saturation, when no new codes appeared in the data. The childrens' stories were imported in the MAXQD software and analyzed to retrieve the main categories and themes. RESULTS: Factors that influenced experiences appeared to be idiosyncratic, but could be classified into three categories: the person accompanying the child, child and dentist-related factors. Two sub-categories of the person accompanying the child were the role of person in their treatment and the types of persons accompanying them. Dentist-related factors included three more sub-themes of applied behavioral management techniques, their role in oral health education, and organization of the office environment. The three sub-themes of children's related factors were experiencing fear, remembering the details of their experience, and type of care received. CONCLUSION: Although the method was limited to the qualitative written stories of children and there was no opportunity to explore more and consider the detailed opinions by face-to-face interviews, some noticeable elements were mentioned by children. The person accompanying the child, child and dentist-related factors were three main categories obtained from the data.

Dental treatments in patients with special needs provided by university medical center in Southern Taiwan: a retrospective study.

OBJECTIVES: We perform special-need dental treatment at outpatient department (OPD), under general anesthesia (GA) when necessary, and provide domiciliary dental care. We aim to evaluate the profile and the characteristics of special needs patients (SNPs). MATERIALS AND METHODS: We consecutively enrolled 3117 SNPs from January 1, 2019 to December 31, 2022. Eighty patients with rare or genetic diseases were excluded. Demographic data were retrospectively collected. RESULTS: There were totally 3037 SNPs (mean age: 48.2 years; range, 1-100; male-to-female ratio, 1.5); 89.1% (n = 2705) SNPs received dental care at the OPD (OPD-SNPs), 7.9% (n = 239) received dental treatment under GA, and 3.0% (n = 93) received domiciliary dental care. Among those SNPs who received dental treatment under GA (n = 239), 91.2% (n = 218) were mental/intellectual disabled, and most underwent cavity filling (69.5%) and dental extractions (56.5%). OPD-SNPs with mental/intellectual disabilities (n = 1340) received significantly more items of dental treatment than those without (n = 1365). SNPs with more severe disabilities received more fluoride application and ultrasonic scaling (both p < 0.001, trend tests). Interestingly, among OPD-SNPs with mental/intellectual disabilities (n = 1340), more severe patients received more fluoride application (p < 0.001) and ultrasonic scaling (p < 0.001) but fewer root canal treatment (p = 0.007, trend test). CONCLUSIONS: GA benefited SNPs with more dental procedures, including invasive items. SNPs with mental/intellectual disabilities can tolerate more measures and SNPs with more severe mental/intellectual disabilities received more preventive measures but less invasive measures. Similarly, more severe SNPs with other disabilities received more preventive measures but not invasive measures. CLINICAL RELEVANCE: Our findings may provide useful information for special needs dentists and for doctor-patient communication.

Accessibility of Patients With Special Healthcare Needs to Dental Care in the Eastern Province of Saudi Arabia: A Multicentre Study From Perspective of Caregiver and Dental Care Providers.

Dental care accessibility is subject to a dentist's qualification, practice and intention to treat patients, regardless of whether those patients have special healthcare needs (SCN) and should receive treatment in a dental setting. This multicentre study aimed to evaluate the characteristics of patients with SCN, their access to dental care and behaviour towards dental care from their caregiver's perspective. In addition, the perspective of dental care providers who care for patients with SCN and the factors affecting the provision of treatment was also appraised. The Eastern Province of Saudi Arabia served as the site of this cross-sectional study from 1 February 2020 to 31 January 2022. Caregivers of 272 patients with SCN, regardless of age and gender, were recruited in the study. The caregiver's proforma sought information on the demographic characteristics, type of disability, cooperation, medical history, occupation of the parent and patient's behaviour towards oral hygiene and dental healthcare. The second proforma had the dental care provider's perspective about the common disabilities, factors that affect the decision to provide treatment, difficulties patients face in getting their dental treatment and, from the dentist's experience, recommendations to improve the access to dental care for patients with SCN. Statistical analysis was carried out by using SPSS version 22.0. The demographic features, caregiver's perception about oral healthcare accessibility and dental professional's point of view were presented as frequencies and percentages. Chi-square test was applied to compare the proportions. The majority of the caregivers were satisfied with the dental service providers (91.9%) for their patients with SCN. The dental care provider's survey results indicated a shortage of dentists (54.7%) in the region and other factors that pose challenges to special care, like the severity of the disability of patients with SCN (50%), family structure (46.7%), treatment cost (35.6%) and transportation (32.8%). Patients with SCN in Saudi Arabia had a high appraisal of access to dental care and were very satisfied with dental treatment results. However, the presence of a dental care provider in the same rehabilitation centre was a major concern. The severity of the disability and the patient's cooperation were the major factors that may have affected the decision of the dental care provider.

The effect of parental presence on the anxiety during first dental treatment in children.

OBJECTIVE: The aim of this study was to evaluate the effect of parental presence on dental anxiety in children during dental treatments. MATERIALS AND METHODS: The study was conducted with 194 children between January-April, 2020. The children were randomly divided into two subgroups. Children in group-I were treated in parent's presence (pp), and in group-II in parent's absence (pa). The Wong-Baker FACES Pain Rating Scale (WBFPS) and The Modified Dental Anxiety Scale (MDAS) were used for subjective measurements, whereas the objective measurement was performed by measuring the heart rate. RESULTS: The mean age of 194 children was 6.26 ± 1.15 years, ranging from 5-8 years of age. The mean MDAS score of all children was 15.1 ± 4.72. No significant correlations were found in terms of dental anxiety between the children's gender and age with heart rate, WBFPS and MDAS scores. Preoperative WBFPSscores (6.83 ± 1.04 pp and 7.01 ± 0.93 pa) were higher than postoperative scores (5.34 ± 2.11 pp and 5.74 ± 2.04 pa), with no statistically significant difference. Although there was no statistically significant results, the paediatric dentist observed a deterioration in the children's behavior throughout the sessions in group-II compared to children in group-I. CONCLUSIONS: Parental presence has no statistically significant effect on dental anxiety in children during dental treatments.

Specialists' management of permanent dentition traumatic dental injuries in 7-16-year-olds: A qualitative study.

BACKGROUND/AIM: Specialist paediatric dentists are integral to dental trauma care pathways. General dentists rely on specialist input, more so in complex cases. Little is known about specialists' role in these pathways or the perceived barriers they face. The aim is to explore specialists' role in managing traumatic dental injuries in the permanent dentition in children. MATERIAL/METHODS: Face-to-face (remote video) online semi-structured interviews were undertaken. All UK specialists were invited by email. Purposeful sampling aimed to investigate representation from the devolved nations, presence/absence of working within a managed-clinical network and level of care provision. Interviews were audio-recorded and transcribed verbatim. Transcripts were thematically analysed. RESULTS: Data saturation was reached after nine interviews. Three main themes established were: inconsistent access to care; the need to formalise traumatic dental injuries care pathways; educationally upskilling general dentists. Geographical variation in provision of specialist and out-of-hours/emergency department care meant patients risked not receiving care by the most appropriate individual. Formalizing care pathways by clearly defining the role of each stakeholder (specialist, dentist, medical professionals and parents) and developing a method to assess complexity was perceived to be essential to improving treatment outcomes. Upskilling general dentists in trauma management appeared essential. A potential lack of engagement was raised, with a suggestion that trauma management education should become core continuing-professional development. CONCLUSIONS: Specialist input should be available in the management of traumatic dental injuries. Current access to specialist care is inequitable across the UK. Formalizing care pathways and upskilling general dentists could ease inconsistencies.

Munchausen syndrome by proxy: A narrative review and update for the dentist and other healthcare professionals.

Munchausen syndrome by proxy (MSbP) is a form of abuse in which a caregiver with Factitious Disorder Imposed on Another (FDIA) fabricates or induces signs or symptoms in a person under their care to satisfy a self-serving psychological need. Unnecessary clinical evaluations, procedures, and treatments that are initiated based on falsification by the abuser inadvertently add to the trauma experienced by the victim. It is a form of abuse and the impact on victims can be severe, sometimes fatal, and far-reaching such as prolonged neglect and extension to affected siblings. The long-term exposure to MSbP may predispose the victim to eventually developing factitious disorder imposed on self (FDIS). While MSbP often involves child victims, elderly, adults, and pets have also been reported as victims. MSbP can be a diagnostic challenge, and the important keys to timely identification of MSbP include the ability to detect deception by caregivers through awareness, clinical suspicion, and careful review of available health records; it also involves collecting collaborative information from other relevant healthcare providers including dentists, schoolteachers, and social workers. To date, there are limited published cases of MSbP with oral findings. This paper provides a narrative review of the current understanding of MSbP with a section on cases with oral findings. This paper aims to increase awareness about the clinical presentations and management considerations for MSbP among dentists and other healthcare professionals.

Dental treatment of children with special healthcare needs: A retrospective study of 10 years of treatment.

BACKGROUND/AIM: Children with special healthcare needs (CSHCN) often face oral health challenges. This retrospective cross-sectional study at a university hospital aimed to determine CSHCN's medical spectrum, dental treatment needs, and mode of treatment: general anesthesia (GA) or outpatient dental care (ODC). DESIGN: Data from the Department of Conservative Dentistry, Heidelberg University Hospital, 2012-2022, were reviewed, considering age, gender, International Classification of Diseases-10 diagnoses, caries experience (dmft/DMFT), restorative parameters, and treatment under GA/ODC. For patients under GA, their American Society of Anesthesiologists (ASA) classification was considered. Descriptive statistics, Kruskal-Wallis test, Mann-Whitney U-test and logistic regression were utilized. RESULTS: Of 669 patients, congenital and chromosomal malformations (34.7%), diseases of the nervous system (19.1%), and mental and behavioral disorders (16.0%) were mainly diagnosed. Dentin caries prevalence was high at 79.1%, with treatments performed mainly under GA (51.4%). The odds of receiving treatment under GA decreased with patient age and increased with higher dmft/DMFT scores. Most under GA were classified as ASA 3 (51.7%), indicating high anesthesia risks. CONCLUSION: Children with special healthcare needs often have diseases that can lead to higher challenges related to cooperation. The high prevalence of dentin caries underscores the substantial need for dental treatments, which were consequently often performed under GA, despite the associated risks. These findings stress the need for trained dental professionals.

Perception of nurses applying silver diamine fluoride to children's teeth: A mixed methods study.

BACKGROUND: No studies have evaluated the unique potential of nurse-led silver diamine fluoride (SDF) application for children to bridge the gap in interprofessional collaboration. AIM: To investigate the attitudes, beliefs and perceptions of nurses regarding nurse-led SDF application at the well-child visit and identify possible barriers and make recommendations. DESIGN: Mixed methods design involving a questionnaire and semi-structured individual interviews were conducted. RESULTS: All eligible nurses (n = 110) completed the questionnaire, and 16 were interviewed. Questionnaire responses highlighted that nurses were not confident in providing oral health services (score: <3 of 5) beyond oral hygiene advice (score: ≥3.9 of 5) but believed that they should be providing these services for individuals with difficulty accessing care. Interviews reflected that most nurses viewed oral health care as an important part of paediatric health but were limited by knowledge, time and manpower. Most were willing to expand their job scope to include SDF application with formal education and training, competency assessments and approaches to counter time limitations. CONCLUSION: Where nurses are already providing basic oral healthcare, nurse-led SDF application could be the next step. Findings suggest that systemic changes should include strategies to empower and motivate nurses to apply SDF at the well-child visit.

Overcoming local anesthesia failure during routine dental treatments in children.

BACKGROUND: Local anesthesia (LA) during routine dental treatment in children fails in 5%-35% of first attempts. No data, however, are available on the success rates of subsequent attempts. AIM: To evaluate the effectiveness of primary, secondary, and tertiary LA attempts (P-LA, S-LA, and T-LA, respectively) for anesthetizing molars during routine dental treatments in children. DESIGN: We retrospectively analyzed dental records of all children (2-18 years) who had been administered LA for the treatment of primary or permanent molars by a single paediatric dentist, between 2011 and 2022. All LAs were delivered using a computer-controlled local anesthetic delivery (CCLAD) system. RESULTS: The failure rate of P-LA in 1312 molars was 13% and correlated with age (p < .001), type of tooth (p < .001), type of treatment (p < .001), and treated arch (p < .001). The effectiveness of S-LA for buccal infiltration, intrasulcular, inferior alveolar nerve block, greater palatine nerve block (GPNB), posterior superior alveolar nerve block (PSANB), or a combination of the last two was 50%, 87.2%, 66.7%, 63.6%, 33.3%, and 100%, respectively, and was not significantly associated with age or the type of tooth, treatment, or P-LA. CONCLUSION: The optimal choice of S-LA for anesthetizing maxillary molars was a combination of PSANB and GPNB, whereas for mandibular molars, it was IS-CCLAD system.

Ethnographic perspectives of mothers and professionals on including children with disabilities in oral health in the Kingdom of Saudi Arabia.

BACKGROUND: Children with disabilities generally face poorer oral health outcomes compared with their non-disabled peers due to a range of factors including inadequate oral hygiene, infrequent dental visits and systemic barriers in accessing care. AIM: This ethnographic study explored the perspectives of caregivers and professionals to identify the ways that children with disabilities are included in oral health. DESIGN: A purposive sample of 10 caregivers, all mothers with disabled children aged 9-15 years, five healthcare providers and five educators in Saudi Arabia, participated. Data collection used participant observation and semi-structured in-depth interviews. Data were analysed using reflexive thematic analysis. RESULTS: The findings suggest that mothers lacked a supportive environment to develop their skills and knowledge about oral health care, preventing them from including their children in oral health. Inaccessible services added to the exclusion of both mothers and children. Some dental professionals exhibited poor communication skills and discriminatory attitudes towards the children and problematising mothers. Educators tended to discuss disabled children in terms of inability, displaying a deficit approach to impairment. CONCLUSIONS: The evidence suggests the exclusion of mothers from oral health. This has an impact on how they enable their children. Recommendations include adopting a social model of disability in dental education and policies in Saudi Arabia to address inequalities. Provision of support, education and focusing on societal barriers moves towards inclusion rather than conceptualising disability as an individual problem.

Timing, reasons, and predictors for first dental visits among children seen at two university hospitals.

BACKGROUND: Dental caries is the most common chronic childhood disease. The recommended age for the first dental visit (FDV) is 1 year, yet a minority of children visit before the age of 3 years. AIM: The aim of the study was to estimate the patterns of and predictors for dental visits among a sample of children. DESIGN: Parents of children between the ages of 6 months and 18 years, who attended the paediatric dentistry clinics and the well-baby clinics, were recruited. A validated questionnaire was used to collect data. Logistic regression was utilized to assess the predictors of ever visiting a dentist. RESULTS: The mean age at FDV was 5.8 ± 2.1 years. Parents' belief of not needing to see a dentist was the most common barrier to visiting a dentist (33%). Among the reasons for FDV, caries and pain were the most common (45% and 20%, respectively). Predictors of ever visiting a dentist were children who are not an only child and children of parents who visited a dentist themselves. CONCLUSION: Children visited the dentist at an age older than that recommended, and the reasons for FDV were mainly caries and its consequences.

Comparison of facilitators and barriers to providing oral hygiene measures in dependent older people and young children: A systematic review.

OBJECTIVE: The objective of the study was to systematically compare barriers/facilitators providing oral hygiene to young children and dependent older people and to generate ideas to improve the implementation of oral hygiene measures. BACKGROUND: Many older people, like children, rely on third-party assistance for teeth cleaning. Barriers/facilitators in providing oral care services have been described in recent works. The aim of our study was to compare these results for both groups and to increase knowledge on analogies/differences in barriers/intermediaries. METHODS: We performed a systematic review. Studies reporting on knowledge, attitudes and beliefs acting as barriers/facilitators for provision of teeth cleaning were included. Thematic analysis was used and identified themes translated to domains and constructs of the theoretical domains framework and aligned to the behaviour change wheel. Based on three published reviews in children or older people, our search (PubMed via Medline), Cochrane Central Register of Controlled Trials (CENTRAL) and Web of Science, Google Scholar, last search (21 January 2023) encompassed both populations dated from their last publication (28 February 2018). The review was registered (Prospero, CRD42021278944). For quality assessment, the Newcastle-Ottawa Scale (NOS) was used. RESULTS: Seventeen articles were identified (older people (n = 8), children (n = 9)). Deficits exist for both in terms of "knowledge/skills" among caregivers, with special difficulties in children with challenging behaviour and older people. "Capability" as one of the main elements of behavioural factors that are the basis for behaviour to take place (COM-B, Capability, Opportunity, Motivation-Behaviour) is most often mentioned for children and "opportunity" for older people. CONCLUSIONS: Most of the facilitators and barriers affecting oral care provision in children are also relevant in older people. Approaches for the development of strategies for better implementation of oral hygiene measures in older people are presented.

Access to oral health care services for children with disabilities: a mixed methods systematic review.

BACKGROUND: Children with disabilities experience poorer oral health and frequently have complex needs. The accessibility of oral health care services for children with disabilities is crucial for promoting oral health and overall well-being. This study aimed to systematically review the literature to identify the barriers and facilitators to oral health care services for children with disabilities, and to propose priority research areas for the planning and provision of dental services to meet their needs. METHODS: This was a mixed methods systematic review. Multiple databases searched included MEDLINE, Scopus, PsycINFO, EMBASE, and CINAHL. The search strategy included Medical Subject Heading (MeSH) terms related to children, disabilities, and access to oral health. Eligibility criteria focused on studies about children with disabilities, discussing the accessibility of oral health care. RESULTS: Using Levesque's framework for access identified barriers such as professional unwillingness, fear of the dentist, cost of treatment, and inadequate dental facilities. Facilitators of access offered insight into strategies for improving access to oral health care for children with disabilities. CONCLUSION: There is a positive benefit to using Levesque's framework of access or other established frameworks to carry out research on oral healthcare access, or implementations of dental public health interventions in order to identify gaps, enhance awareness and promote better oral health practices. The evidence suggests that including people with disabilities in co-developing service provision improves accessibility, alongside using tailored approaches and interventions which promote understanding of the importance of dental care and increases awareness for professionals, caregivers and children with disabilities. TRIAL REGISTRATION: Protocol has been registered online on the PROSPERO database with an ID CRD42023433172 on June 9, 2023.

Evaluating the effectiveness of web-based oral health education on enhancing mothers' awareness: a semi-experimental internet-based intervention.

OBJECTIVES: This study examined the impact of web-based education on enhancing mothers' awareness of oral health care for children aged 9 and 12 years. It focused on the crucial role of mothers in educating about oral health to prevent dental diseases and reduce long-term healthcare costs. METHODS: Mothers were divided into three groups: control, intervention with a web system, and intervention with a brochure. Over one month, their knowledge about their children's oral health was assessed before and after the intervention. RESULTS: Data were analyzed using parametric t-tests and non-parametric Mann-Whitney U tests. The findings indicated a significant increase in parental awareness in both intervention groups. CONCLUSION: It is recommended that parent education be done using web-based systems or mobile apps, which are better choices due to greater accessibility and interactivity.

Oral health care among children in Saudi Arabia: a cross-sectional study.

BACKGROUND: Oral health is crucial for caries prevention. Research reported variations in oral health practices among countries and individuals. Therefore, this study aims to examine and compare oral hygiene practices among children aged 3 to 11 years old across five areas of Saudi Arabia. METHODS: This cross-sectional study includes healthy children aged 3 to 11 from five areas/regions of Saudi Arabia. A self-administered, validated parental questionnaire was constructed according to the WHO Oral Health Questionnaire for children, which inquires about the child's socio-demographic factors, oral health evaluation, and oral hygiene practice. RESULTS: Out of the 1516 parents who participated, 21.2% reported their children brushing twice a day. Regression analysis found that the first-born children and those who visited a dentist displayed a significantly higher adjusted odds ratio (AOR) for parents reporting that their child practices oral health care compared to only children (AOR: 2.837; P = 0.016) and to those who did not visit a dentist in the last 12 months (AOR: 2.989; P < 0.001). CONCLUSION: This study highlights that only 21.2% of parents reported their children practicing excellent oral hygiene by brushing twice a day. This underscores the importance of early dental visits, customized interventions, and prevention programs that account for regional and demographic factors, such as birth order, to effectively promote oral health.