Effectiveness of an integrated model of oral health-promoting schools in improving children's knowledge and the KAP of their parents, Iran.

INTRODUCTION: The aim of our study was to investigate the effect of an Oral Health Promoting School (OHPS) model on children's oral health in Iran. METHODS: This interventional quasi-experimental study was conducted in the academic year 2019-20 among 354 primary school students and their parents. A questionnaire including 17 questions was distributed among children before and 5 months after the program (The ranges of possible scores = 0-17). Training workshops for the parents based on the theoretical domains framework were designed. Using educational sessions, pamphlets, tooth brushing dairies, assignments to do at home, educational videos and messages as reminders in social networks, parents were educated about dental caries, its risk factors and prevention principles. Best recommended oral health behaviors including tooth brushing and the use of fluoridated tooth paste were also educated. A questionnaire consisting of 18 knowledge (The ranges of possible scores = 0-18), 13 attitude and 10 practice questions were distributed among parents before and after the workshops. The data were fed into SPSS and analyzed by descriptive and analytic statistics such as T-test, ANOVA and Correlation Coefficients (α = 0.05). RESULTS: The mean pre-test knowledge (7.8 ± 1.7) was increased significantly in three schools after program, p < 0.001. In the post-test, girls gained significantly higher scores (9.61 ± 1.98 vs. 9.06 ± 1.4, p = 0.025). Among 147 parents, the mean knowledge was raised from 12.3 ± 3.1 (5-18) to 15 ± 3.03 (6-18), p < 0.001. Knowledge score of the parents attending both sessions was higher. Practice of the parents regarding the use of fluoridated tooth-paste was significantly improved (p < 0.001). Also, their attitude toward the ability of children to take care of their teeth was improved (p = 0.029). Based on the self-report of parents, 71.4% (n = 47) of mothers and 45.6% (n = 67) of their children used to brush once or two times daily and there was a correlation between their behaviors (p < 0.001, Spearman Correlation Coefficient = 0.4). CONCLUSION: It seems that the education provided in OHPS had positive effects on increasing students' awareness and to some extent, the knowledge, attitude and practice of the parents.

Competencies of dental public health for undergraduate students and their self-perceived achievements: The case of Iran.

PURPOSE: The aim of this study was to develop Dental Public Health (DPH) competencies and to assess the self-perceived achievements of undergraduate students in regard to these competencies. MATERIALS AND METHODS: In the first phase, by using the mixed method of the RAND-UCLA model, a list of the proposed competencies was developed and validated based on three-round expert consensus using both rating and group discussing method. In the second phase, 120 senior (final-year) dental students were asked to determine their achievements based on the finalised list of competency statements on a 0-10 numerical scale. Descriptive statistical analysis was then performed using SPSS (version 22) to determine the mean score of the items and domains. Some background factors were also tested for any relationship. RESULT: After three rounds of implementing the RAND-UCLA method, 31 statements in 10 domains were developed and validated. The mean total score of the self-reported competency was 176.87 ± 52.4 amongst the recruited dental students with a range of 37 to 304. The highest mean ± sd score (7.7 ± 1.8) was found for the preventive oral health services field, whilst the lowest one (4.5 ± 2.3) was reported for understanding the components and functions of the health system. The average self-reported scores of professional ethics and professionalism, evidence-based practice and oral health determinants were also acceptable amongst them. CONCLUSION: The finalised competencies gained the consensus level of agreement and appropriateness by representatives of all DPH experts in the country. However, according to the dental students' self-reports, they had moderate competencies in most cases. Therefore, content and applied methods of training and evaluation may need to be revised to support students' development. Also, the complementary evaluation method at real work setting is highly suggested.

Assessing the oral health-related quality of life in Iranian adolescents: validity of the Persian version of the Child Oral Health Impact Profile (COHIP).

PURPOSE: To evaluate the psychometric properties of an oral-health related quality of life (OHRQoL) instrument for application in the population of Iranian adolescents and to assess the discriminate and convergent validity and reliability of the Persian version of the Child Oral Health Impact Profile (COHIP) in a representative sample of this population. MATERIALS AND METHODS: Using multistage stratified sampling, 597 schoolchildren aged from 13 to 18 years living in the city of Isfahan were recruited to complete the Persian COHIP questionnaire. They were also examined for dental caries and malocclusion by two trained, calibrated examiners. RESULTS: Overall COHIP scores ranged from 15 to 135 (mean ± SD: 103.6 ± 18). Sixty-six percent of the students experienced at least one frequent oral health-related impact over the past three months. The Cronbach alpha coefficient was 0.89 for the overall score. Discriminate validity was supported by the significant difference between COHIP scores in the caries-free group and the others (P = 0.01). In addition, the questionnaire was able to differentiate among the groups by various degrees of need for orthodontic treatment (P < 0.01). Convergent validity was confirmed by significant association between the quality of life scores, the self-perceived health and oral health ratings and the self-perceived treatment need (r = 0.36, 0.57, -0.40). CONCLUSION: The Persian COHIP demonstrated acceptable psychometric properties for the descriptive purposes. Some discrepancies observed between the clinical data and quality of life status were confirmed by the perceptual identity of such indices influenced by several overt and covert variables.

Attitude of dental students toward evidence-based dentistry in Iran: A systematic review.

Background: Dentistry practice has become more complex and challenging in the recent years. The clinical decision-making process has experienced many problems due to changing socioeconomic patterns, knowledgeable patients, rapid technological advances, and information explosion. The present study reviewed the status of the attitude toward evidence-based dentistry (EBD) among dental students of Iran Universities. The effect of the educational intervention was also assessed. Materials and Methods: This systematic review was conducted according to the Preferred Reporting Items for Systematic review and Meta-Analysis checklist. Search strategy was developed by Medical Subject Headings terms and keywords surfing electronic available databases including Medline/PubMed and Google Scholar and local databases such as Scientific Information Database (SID) and Magiran. Two reviewers read the abstracts of all eligible papers and excluded the duplicates. They extracted the information of the full-text of the studies included in the review and assessed the quality by Joanna Briggs Institute critical appraisal checklist. Results: Ten studies including 8 cross-sectional and 2 interventional studies met the criteria. The assessment of the attitude of 937 dental students from a different region of the country toward EBD showed moderate to acceptable status using 3 different tools. In regard to educational interventions, 2 studies were successful to improve their attitude. Conclusion: Although the researchers presented good scores on the attitude questionnaires, the quality of the study tools, the eligible criteria for recruiting the participants and the method of evaluating the construct of attitude should be investigated in future studies.

A comparison of two orthodontic aesthetic indices.

OBJECTIVES: A cross-sectional study was conducted to determine the level of agreement between the Dental Aesthetic Index (DAI) and the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN). METHODS: DAI and AC scores were recorded in 728 subjects (340 females and 388 males, aged 11-20 years). The percentage of subjects needing treatment and the different treatment categories for the DAI and AC were gender compared. Spearman's rank correlation coefficient (rho) was used to explore the relationship between the DAI and AC scores. Observer determined and Kappa statistics were used to analyse the diagnostic level of agreement between the DAI and AC, sorted into 'yes' or 'no' categories of orthodontic treatment need. RESULTS: According to the DAI and AC, 21.8 and 10.9% of subjects were in need of treatment, respectively. Significant positive correlations existed between the DAI and AC scores (rho = 0.795). The DAI had a lower treatment need threshold compared with the AC. The Kappa statistics and percentage agreement between the DAI and AC was 0.55 (95% CI: 0.46-0.63) and 87.6%, respectively. CONCLUSION: The DAI and AC showed strong association. However, only a moderate level of diagnostic agreement was identified (12.4% difference in observed percentage agreement) which highlights the need for a unified and universal orthodontic index for consideration when interpreting, comparing, or quantifying treatment needs.

A model for implementing oral health-promoting school: Integration with dental students' educational curriculum: A protocol study.

BACKGROUND: Schools are ideal setting for children's oral health-promoting programs. It is an integrated model for oral health-promoting schools (OHPS) with the capacities of dental school's curriculum and dental students as workforces. In this protocol, the principle of planning and implementation of the oral health program is described. MATERIALS AND METHODS: Based on the PRECEDE-Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development (PROCEED) planning model, a framework for determining the potential predisposing, reinforcing, and enabling factors that could be intervening was diagnosed. To adapt the phases of the planning model for integration of the "OHPS" principles and the dental students' curriculum, the following steps are supposed to be considered: Phases 1-5 which are to assess the baseline data will include the assessment of children oral health status and parents and teachers' knowledge, attitude, and performance. Phase 6 or implementation phase will be allocated to oral health education interventions for students, parents, and teachers, professional screening, prevention, and referral. Phase 7 or the process assessment phase will be to record the number of screened students, the amount of fissure sealant and fluoride provision, and percentage of trained parents and teachers. Phase 8 or the impact assessment phase will assess the students' improvement in knowledge and practice, decayed, missing, and filled teeth scores, teachers and mothers' oral health attitudes and behaviors, and brushing and flossing behaviors. At the last, cost analysis of the program and long-term monitoring of the interventions is suggested. CONCLUSION: In case that the effectiveness of this model is proven, it can be implemented by other dental schools for the primary schools in their regions. Considering the number and distribution of dental schools in the country, this model is executable as targeted population oral health promotion approach in 6-12-year-old schoolchildren.

Continuing professional development programs for general dentists in Isfahan province, Iran: Interests, priorities, and obstacles.

Background: Continuing professional development (CPD) is a life-long learning process for all health-care members including dentists to improve their knowledge and skills in their profession and provide the best quality services. This study aimed to assess the needs, priorities, and obstacles of attending dentists in these programs in Isfahan province, in 2020. Materials and Methods: This descriptive-analytical cross-sectional study was performed on general dentists in Isfahan province. Data were collected through a three-part questionnaire, online and on paper; it included demographic information, prioritization of seven disciplines, and scoring of 33 dental subfields, as well as obstacles limiting participation in the CPD programs. This questionnaire was developed and validated by researchers. Statistical analysis was carried out through Mann-Whitney, Kruskal-Wallis, and Chi-square tests, and a significance level of 0.05 was considered. Results: Of 326 dentists (90.5% response rate) participating in this study, 157 were (48.2%) female, and most of them were in the high work experience group (45.1%). The highest mean scores standard deviation related to the dentist's interest and needs, among the seven dental disciplines, belonged to practice management (6.68 [2.9]), oral and dental reconstruction (6.29 [2.55]), and pediatric dentistry (6.291 [2.87]). On the other hand, lack of time (70.6%), inefficient teaching methods and organization (65%), and irrelevant topics (58.6%) were the most common obstacles limiting dentists in the CPD programs. Conclusion: Based on the results of this study, dentists in Isfahan province reported more interest and need to participate in some fields of CPD courses including practice management, pediatric dentistry, and oral and dental reconstruction. Thus, a system for continuing education based on dentists' needs and preferences is highly suggested.

Association between orthodontic treatment need and caries experience.

OBJECTIVE: To investigate the association between orthodontic treatment need (OTN) and caries experience (CE). SUBJECTS AND METHODS: Using a stratified sampling method, 748 subjects (355 females, 393 males; mean ± standard deviation age 15.11 ± 2.23 years) were examined. The Dental Aesthetic Index (DAI), DMFT, simple (DMFT > 0) and severe CE (DMFT > 8) were recorded. Socio-economic status (SES) was assessed by recording parental education, mother's employment status, and household size. RESULTS: Higher (but not statistically significant) CE was observed in subjects with OTN (DAI > 30). The association between DAI and DMFT scores was not significant (rho = 0.05). Mean DMFT score did not vary significantly between the SES and OTN subgroups. In children with a household size >6 persons (n = 85), OTN was associated with higher CE and a higher prevalence of severe CE compared with those without OTN. In this group, when DAI treatment need grade increased, severe CE prevalence also increased from 10.8% to 50%. Similarly, in those with OTN and household size >6 persons, the odds of observing subjects with severe CE was 4.6 times higher (95% confidence interval 1.45-14.55) compared to those without OTN. CONCLUSIONS: Associations were observed between OTN and CE and also between the prevalence of severe CE and the severity of malocclusion in children with a household size >6 persons. The current findings suggest that the relationship between caries experience and malocclusion should be assessed in a wider context of SES and background factors.

Fissure sealant therapy as a portable community-based care in deprived regions: Effectiveness of a clinical trial after 1 year follow-up.

The aim of this study was to evaluate the effectiveness of the fissure sealant therapy in suboptimal setting (as part of a community-based program using the portable equipment and provided by dental students) on the caries status of school children. This pragmatic split-mouth randomised clinical trial was conducted in rural area of Iran. At baseline, 124 patients, including 185 paired teeth with deep pits and fissures of opposite quadrants that were either healthy or at early stages of enamel decay (International Caries Detection and Assessment System [ICDAS] 0-2), were randomly allocated to receive fissure sealant or acted as control. The incidence of new caries (ICDAS code 3-6) and the sealant's retention status after 1-year follow-up were evaluated. Using chi-square test, the relative risk (RR) and the Number Needed to Treat (NNT) to prevent new caries were calculated. After 1 year, 109 patients including 163 paired teeth were available. Sixty-seven (41.4%) and 44 (27.2%) teeth had complete and partial retained sealants respectively. The risk of caries incidence in non-sealed teeth was almost three times more than sealed teeth (RR = 2.88, 95% CI: 1.4-1.97, p = 0.002) and the NNT was 10 (95% CI: 6-26). A significant association was noted between the status of sealant retention after 1 year and the incidence of new caries (p < 0.001). Fissure sealant as part of a community-based program was effective in controlling caries incidence.

Development an Electronic Oral Health Record application for educational dental setting.

AIM: Worldwide, the adoption of electronic patient recording system is increasing among many parts of the health sectors. Although paper-based recording of patients' information was a routine in many departments of dental schools, easy destruction of collected information and the costs of its conversion to electronic data, limited the availability of updated data at the department of dental public health. This paper aimed to explain the project of designing a system for Electronic Oral Health Recording (EOHR) in Isfahan dental school. The initial testing of system among dental students is reported too. METHODS: A situation analysis was conducted among the faculty members and dental students dealing with the Department of Oral Public Health. The content of EOHR was developed based on the WHO STEPwise model for chronic disease surveillance systems. The system was developed as an application for smartphone and a web-based database. The spiral model was applied in software development which was accomplished by the object-oriented programming method. After that, alpha and beta testing were done in target population. Data were compiled during the interview and oral examination by 40 dental students among 200 schoolchildren. It has been stored as a data bank following the network connection. The pitfalls of the system during its usage in dental public health course were evaluated as well. RESULTS: The baseline analysis of situation generally revealed a perception of need to change the existing paper-based recording system among the dental students and the academic members; it was summarized in five areas as follows: benefits restrictions, structural barriers, perceived advantages and feasibility. The application was designed and completed as six pages interface including demographic and follow-up page, socioeconomic status of family, oral health-related behavior, dental and gingival status, and quality of life. Drawbacks, such as nonresponded items, common assumptions, student registration page on the mobile, and modification in the output Excel file for analysis variables, have been resolved. CONCLUSION: A software application and web-based database were designed regarding the characteristics of Agile Unified Process development and educational dental setting. This system should be improved and established gradually.

Cross-Cultural Adaptation of Persian Version of Scale of Oral Health Outcomes for 5-Year-Old Children.

OBJECTIVES: Indicators of oral health-related quality of life (OHRQoL) in children are widely adopted to evaluate the effects of oral problems. Recently, the scale of oral health outcomes for 5-year-old children (SOHO-5) was developed based on the children's self-reports. This study aimed to evaluate the validity and reliability of the Persian version of the questionnaire in a sample of Iranian children. MATERIALS AND METHODS: This cross-sectional study was conducted on 160 children from four areas of Isfahan selected via non-random purposive sampling. After forward-backward translation of the questionnaire, content and face validity evaluation, a pilot test was carried out. Children forms were completed by interview, while parents forms were self-administered. Test-retest reliability was evaluated in 30 subjects. Construct validity, internal consistency and descriptive quality of life score were assessed with SPSS 18. The child-parent agreement was measured with correlation test and paired t-test (α=0.05). RESULTS: The mean (±standard deviation) quality of life scores in children and parents were 2.3±3 and 1.3±1.9, respectively. The most prevalent impacts were difficulty sleeping and eating. The Cronbach's alpha coefficients were 0.82 and 0.67 for the child and parent versions, respectively. Significant correlation of the scores with the oral health rating, pain history and perceived need for treatment confirmed its construct validity (r: 0.4-0.6, P<0.05). The hypothesis of the agreement was not supported (P>0.05). CONCLUSIONS: Based on the findings, the Persian version of SOHO-5 has acceptable reliability and validity for use in the pediatric population of Iran while there were some conflicts by parents.

Effectiveness of a program on evidence-based dentistry in dental students.

INTRODUCTION: Evidence-based dentistry (EBD) is an approach to oral healthcare by combining the best scientific evidence and clinical diagnostics, clinical expertise of the dentist, and the patient's treatment needs and preferences. The aim of the present study is to evaluate the effectiveness of an education program on EBD offered in a community-dentistry course in improving knowledge and attitudes of students in this regard. STUDY METHODS: By a quasi-experimental study design, 64 senior dental students of Islamic Azad University of Khorasgan recruited in a controlled trial. All of the students were randomized as intervention (32) and control (32) groups. A course-based educational program on EBD was randomly assigned to one group. Actual knowledge, self-assessed knowledge, and attitudes, before and after education, were measured in both groups. A questionnaire consisted of 40 items developed by the researcher was used after confirming its validity and reliability. The difference between mean scores at two timelines were measured and compared in three fields by paired t-test and independent t-test analysis via SPSS version 20 software. RESULTS: While the mean scores of actual and self-assessed knowledge and attitude were not significantly different between two groups at the beginning of the program (P > 0.05), the mean scores of all fields in the intervention group were significantly more than those of the control group after education (P < 0.001). The effect size of intervention was 86%, 62%, and 57% in three fields, respectively. There was not a significant difference between mean scores of three fields in the control group, after the intervention. CONCLUSION: Due to the poor knowledge and attitudes of students and improved knowledge and attitudes of the intervention group after education, the education program seems to be effective. Durability of educational impact and evaluating evidence-based performance can be studied in the future.

Social factors and dental health in the urban adolescents of Isfahan, Iran.

AIM: The aim of this study is to determine the dental caries and oral health behavior status of urban adolescents in Iran. Also it assesses the influence of the socioeconomic background on their oral health outcomes. METHODS: A cross-sectional study was conducted in the students living in the city of Isfahan, Iran. 597 adolescents by 13 to 17 years old participated in the study. The asset-based wealth index, household income and parents' educational history were the indicators of socioeconomic status. Data on tooth brushing frequency and smoking experience were collected, and the adolescents were examined for their dental health status. The index of DMFT was recorded by two calibrated examiners considering the criteria of World Health Organization. Bivariate analysis and multivariate regressions were employed to explore the association between dental caries status and socioeconomic variables. RESULTS: The DMFT mean (SD) of the study population was 2.79(2.7) with attributable 50, 4 and 46 percent to D, M and F components and 26% caries- free prevalence. Nearly 19% of the students presented twice daily brushing and 3% of respondents had smoking experience. Dental caries did not show any linear relationship with the social indicators when the DMFT was modeled by the wealth index, parents' educational level and family income adjusted for age and gender. Without adjustment, lower income has increased the chance of untreated tooth decay, 2.5 times among the students. CONCLUSION: Despite the supporting findings on inequalities in oral health, this study did not show a direct association between socio economic backgrounds of the adolescents with their dental health/disease. The hypothesized balanced risk exposure is considered to justify the results, but it needs to be studied by further comprehensive analysis.

Evaluation of orthodontic treatment need by patient-based methods compared with normative method.

BACKGROUND: A comprehensive system of assessing orthodontic need requires the integration of normative clinical measures with patient-based indicators. This study sought to discover weather an oral health-related quality of life measure or Aesthetic Component of Index of Orthodontic Treatment Need (AC-IOTN) could be used as a predictor of orthodontic treatment need. Factors affecting the judgment of patient and dentist about this need are discussed. MATERIALS AND METHODS: Oral examination on 597 Iranian students between 13 years and 18 years was done to reach the grade of Dental Health Component (DHC). The Child Oral Health Impact Profile (COHIP) and AC-IOTN were recorded. The diagnostic values of subjective tests were assessed. Multiple logistic regressions were applied to investigate the role of variables in the persons' perceptions. RESULTS: Half of the 570 eligible students did not need orthodontic treatment either on professional or self-assessment; 60% of patients with definite need had a distinct impact on their quality of life. The specificity of AC to detect the healthy persons was excellent (0.99) but its sensitivity was low (0.08). COHIP score gave a better sensitivity but its specificity was 50%. Caries experience, quality of life, father's education, and brushing habits were the factors relating to the same judgment of persons and dentists (P > 0.02). CONCLUSION: Regarding the discrepancies between two assessment methods, present instruments did not meet the predictor's competencies. The patient-based methods could not substitute the professional assessment, but by identification, the persons with higher impacts would benefit the prioritization process.

Assessment of orthodontic treatment need in 11- to 20-year-old urban Iranian children using the Dental Aesthetic Index (DAI).

AIM: To determine with a cross-sectional study the prevalence of orthodontic treatment need using the Dental Aesthetic Index (DAI). SUBJECTS AND METHODS: Using a stratified sampling method in private and public schools in Isfahan, Iran, 748 subjects were examined and divided into three age groups: 11 to 14, 14 to 17, and 17 to 20 years (355 females and 393 males, 15.11 ± 2.23 years), including 20 subjects with history of orthodontic treatment. DAI scores were recorded in those without history of orthodontic treatment (n=728, 340 females and 388 males). The proportions of subjects within sexes needing treatment, as defined by having DAI scores of at least 31, were compared using the chi-square test. The chi-square test was also used to test for any difference for DAI treatment categories in different age groups and also to test for sex dimorphism. RESULTS: The mean DAI score was 26.14 (SD=7.64) points (95% CI, 26.60 to 26.72). On the whole, 54.5% showed no need or slight need for treatment. In 23.6%, the need for treatment was elective. However, in 11.0%, treatment was highly desirable and 10.9% showed very severe malocclusions and treatment was mandatory. There was a significant difference between sexes with regard to DAI treatment need categories (chi-square=10.10, df=3, P<.05). There was no significant difference between different age groups with regard to DAI treatment categories (P>.05). CONCLUSION: According to our findings, 21.8% of the evaluated Iranian school children in our sample had a DAI score above or equal to 31 points, suggesting highly desirable or mandatory orthodontic treatment need.