The role of oral and prenatal healthcare providers in the promotion of oral health for pregnant women.

BACKGROUND: Hormonal alterations and lowered immunity during pregnancy aggravated by poor oral hygiene increase the risk of pregnant women of developing oral diseases. We conducted this cross-sectional study to examine the role of oral and prenatal health providers in promoting dental care for pregnant women attending primary healthcare centers (PHCs) in Saudi Arabia. METHODS: An online questionnaire was sent to a random sample of women who attended PHCs in Jeddah, during 2018-2019. From a total of 1350 women who responded to our questionnaire, 515 women reported having a dental visit before pregnancy. These women comprised our study sample. Bivariate analyses and multiple logistic regression models were conducted to examine associations between oral practices of dental and prenatal health providers (exposures) and women's utilization of dental care during pregnancy (outcome). Covariates included age, education (< 12 years of education, 12 years of education, and > 12 years of education), family income (≤ 5,000, 5,001-7,000, 7,001-10,000, and > 10,000 Saudi Riyals), health insurance (yes/no), nationality (Saudi Arabian/non-Saudi Arabian), and presence of dental problems, such as toothache, dental caries, gingival inflammation, and the need for dental extractions. RESULTS: Only 30.0% of women were informed by a dentist during their dental visit before pregnancy about the importance of visiting a dentist during pregnancy. About 37.0% of women were asked about oral health, 34.4% were informed about the importance of dental care during pregnancy, and 33.2% had their mouths inspected by prenatal health providers. Women informed by dentists about the importance of dental visits during pregnancy were twice as likely (Odds ratio [OR]: 2.42, 95% confidence interval [CI]: 1.63-3.60) to visit a dentist during pregnancy. Women who were referred to dentists, had their mouth inspected, or were advised to visit a dentist during pregnancy by prenatal providers were 4.29 (95% CI: 2.67-6.88), 3.79 (95% CI: 2.47-5.82), and 3.37 (95% CI: 2.16-5.27) times as likely to visit a dentist during pregnancy. CONCLUSION: The partaking of oral and prenatal healthcare providers in evidence-based oral health promotion practices, antenatal-dental collaboration, and closing the referral loop increase pregnant women's access to and utilization of preventive and treatment dental services.

Fetal Maturation and Intrauterine Survival in Asian American Women by Ethnicity.

OBJECTIVES: Although there are multiple ethnic subgroups of the Asian race, this population is usually treated as homogenous in public health research and practice. There is a dearth of information on fetal maturation and perinatal outcomes among Asian American women compared with their non-Hispanic (NH) White counterparts. This study aimed to determine whether fetal maturation, as captured by gestational age periods, influences the risk of stillbirth in Asian American fetuses, in general, as well as within different ethnic subgroups: Asian Indian, Korean, Chinese, Vietnamese, Japanese, and Filipino, using NH Whites as referent. METHODS: We included singleton births within 37 to 44 gestational weeks occurring in Asian American and NH White mothers from 2014 to 2017. Adjusted logistic regression models were used to quantify the association between mother's race/ethnicity and risk of stillbirth by gestational age phenotypes: early-term, full-term, late-term, and postterm. RESULTS: Compared with NH Whites, Asian Americans had 35% (adjusted odds ratio 0.65, 95% confidence interval 0.53-0.76) and 28% (adjusted odds ratio 0.72, 95% confidence interval 0.59-0.85) lower risk of early-term and full-term stillbirths, respectively. CONCLUSIONS: Our study suggests the existence of differential maturation of the fetoplacental unit as explanation for the decline in intrauterine survival advantage with advancing gestational age among Asian American subgroups.

Oral manifestation and dental treatment of pediatric patient with beta-mannosidosis: A case report.

ß-mannosidosis is a rare autosomal recessive lysosomal storage disease of glycoprotein catabolism caused by a deficiency of ß-mannosidase. Clinical presentation includes intellectual deficits, hearing loss, and recurrent respiratory infections. This report describes the dental treatment and follow-up dental care of a child with ß-mannosidosis. The patient presented to the dental clinic at the age of 6 years with a localized swelling of his lower posterior teeth. Sickle cell disease and physical and mental developmental delays were noted. Clinical examination revealed a flattened nasal bridge, large head, short neck, open bite, gingival overgrowth, macroglossia, enlarged pulp chambers, and poor oral hygiene. Surgical treatment under general anesthesia included extractions, pulp therapy, and restorations. Four years later, the child returned with generalized gingival inflammation and new carious lesions. Periodontal and restorative treatment was provided, and a preventive dental regimen was established. Mannosidosis cases require complex dental procedures, consultations, and prompt follow-up.

Knowledge, attitudes, and practices of oral cancer prevention among students, interns, and faculty members at the college of dentistry of Jazan University.

BACKGROUND: Oral cancer awareness among current and future dental practitioners plays a substantial role in the early detection and prevention of oral cancer. Therefore, this study aimed to assess the knowledge, attitudes, and practices (KAP) of oral cancer prevention (OCP) among oral health practitioners in the College of Dentistry at Jazan University, Saudi Arabia, and to determine factors that facilitate, or limit practices related to oral cancer prevention. METHODS: A self-administered questionnaire survey was done among dental students (n = 274), interns (n = 81), and faculty members (n = 117) in the College of Dentistry at Jazan University between May 2019 to February 2020. The questionnaire was developed in English and modified from a previously validated and published questionnaire into Arabic. It covered every KAP of oral cancer prevention that was useful in accomplishing the study's objectives. Logistic regression analysis was utilized to determine the factors associated with the practice of oral cancer prevention in the past year. RESULTS: Only 29.7% reported having participated in any OCP activities in the past 12 months while about 42% and 53% of participants referred suspected oral cancer patients to the departments of maxillofacial surgery and oral medicine, respectively. Most of the participants had poor knowledge (71.9%), unfavourable attitudes towards OCP (83.6%) and poor levels of practice (62.9%). The study found that the attitude of the participants was significant in influencing their practices of OCP in the previous 12 months, after adjusting for all other factors. CONCLUSION: It was concluded that the level of knowledge, attitudes, and practices of OCP among the sample population was poor. The survey findings suggest that oral health practitioners in Jazan are inexperienced in the methods to adopt for prevention and early detection of oral cancer, despite the high prevalence of oral cancer among province residents. Further research should investigate effective educational strategies and training for improving the participation of students, interns, and faculty members in oral cancer prevention activities.

Factors associated with the use of fashion braces of the Saudi Arabian Youth: application of the Health Belief Model.

BACKGROUND: In spite of the fact that fashion braces (FBs) have been in the spotlight in recent years among both orthodontists and the general public in several countries, there is still limited evidence regarding FBs. The aim was to identify health-related behaviors in using FBs by considering the Health Belief Model (HBM). METHODS: A cross-sectional study with a random sampling technique was conducted in Jazan, Saudi Arabia. The data was obtained from different middle and high schools students, and first-year students at Jazan University. The questionnaire collected data on demographic characteristics and 27 items to examine the constructs of the HBM. Chi Square test was carried out to establish the factors associated with using, the intention to use, and previous knowledge on the use of fashion braces. Logistic regression analysis was utilized to determine the factors associated with the use of fashion braces. RESULTS: 406 study participants completed the questionnaire with a response rate of 88.3%. Majority of respondents were males (52.2%) and > 19 years old (44.3%). Only 9.9% students had used the FBs. However, 25.7% of students had the intention to use them. The perceived susceptibility, perceived benefits and cues to action constructs scores were fair with the mean values of 15.38 (SD = 9.4), 28.17 (SD = 10.8) and 6.65 (SD = 2.50), respectively. However, the perceived barrier score was high with the mean values of 22.14 (SD = 7.50), and lower score of self-efficacy with mean of 8.73 (SD = 3.30). Gender, age, monthly income (family), and education level were significantly (p < 0.05) associated with the use of fashion braces among the study's participants. Based on the results of logistic regression analysis family income, perceived susceptibility, and risk severity constructs predict the use of fashion braces in the study's sample. CONCLUSIONS: The current study suggests that the family income, perceived susceptibility, and risk severity of students significantly influence the use of fashion braces. Hence, it is recommended that researchers should investigate effective educational strategies and programs for improving young people's knowledge about fashion braces and focus more on low family income students so that their using of fashion brace will be decreased.

Factors Associated with Infection-Control Behavior of Dental Health-Care Workers During the COVID-19 Pandemic: A Cross-Sectional Study Applying the Theory of Planned Behavior.

OBJECTIVE: The objective of this study was to evaluate the usefulness of the extended theory of planned behavior (TPB) in predicting COVID-19-infection prevention and control (IPC) among a sample of dental health-care workers (DHCWs) in Saudi Arabia and to examine their behavioral beliefs, normative beliefs, and control beliefs to better understand their views about COVID-19 IPC. METHODS: An online cross-sectional survey was administered among DHCWs in Saudi Arabia using convenience sampling. A questionnaire collected data on demographic characteristics and the 43 items from the TPB construct. One-way ANOVA and Independent sample t-tests were used to establish factors associated with TPB-construct scores. Multiple regression analyses with adjusted effects were used to identify significant predictors for intention from attitudes, subjective norms, and perceived behavioral control variables. The significance level was set at 0.05. RESULTS: A total of 324 study participants completed the questionnaire for a response rate of 40.5%. The majority of respondents were male (59.8%) and aged 25-30 years (32.7%), followed by 31-35 years (31.2%). Only 28.4% reported having participated in IPC activities. With a mean of 41.60±6.26), it was evident that study participants had a favorable attitudes toward COVID-19 IPC. Subjective norms and perceived behavioral control subscale scores were low, with the means of 28.95±5.44) and 34.89±6.49), respectively. The constructs of attitude toward behavior (p<0.001) and subjective norms (p<0.001) significantly predicted the DHCWs' intention to practice COVID-19 IPC behavior, accounting for 44.3% of the variance. CONCLUSION: The current study suggests that the attitudes and subjective norms of DHCWs significantly predicted their intentions regarding COVID-19 IPC behavior. As such, it is recommended that comprehensive education and training programs on infection control pertaining to COVID-19 be implemented among DHCWs in Saudi Arabia so that their attitudes and behavior toward infection prevention are amplified.

Effectiveness of a School-Based Tobacco Prevention Program for Middle School Students in Saudi Arabia: A Quasi-Experimental Controlled Trial.

OBJECTIVE: To evaluate the effect of a school-based tobacco program in preventing initiation of tobacco use among adolescents in Saudi Arabia. METHODS: We used a quasi-experimental controlled design. Four intervention and four control schools were selected from the regional education registry. A baseline questionnaire was administered to all grade 7 students before implementing the tobacco prevention program, Dentists Fighting Nicotine Dependence (DFND). The intervention group (n =379) received the DFND program whereas the control group (n = 255) received the regular tobacco program administered by the Department of Education. The program was delivered by trained health educators over 5 weeks. Pre- and post-test surveys (immediate and 2-year post-intervention) were collected. Study outcomes were current tobacco use, tobacco knowledge, attitude towards not using tobacco, and perceived behavioral control (PBC) of tobacco use. Covariates included sex, parent education, academic performance, absenteeism, student allowance, and religiosity. Data were analyzed using a two-level hierarchical mixed models. RESULTS: In the immediate post-test, 597 participants (intervention, n = 366; control, n = 231) were surveyed. There was no difference in tobacco use between intervention and control schools, however, the intervention group had significantly higher mean scores for knowledge (ß = 1.27, SE = 0.27, P < .01) and attitude toward not using tobacco (ß = 5.17, SE = 2.48, P < .05) after adjusting for covariates. At 2-year post-intervention, 463 participants (intervention, n = 289; control, n = 173) were surveyed. There were no differences in tobacco use, knowledge, attitude or PBC between intervention and control groups. CONCLUSIONS: Our program did not impact tobacco use. In the short-term, the program significantly improved knowledge and attitude towards not using tobacco. These effects decayed 2 years post-intervention without additional programming. Increasing the effectiveness of DFND may be achieved by expanding curriculum content and practice time throughout the school years and by targeting high-risk adolescents within the program.

Need for dental care drives utilisation of dental services among children in Saudi Arabia.

OBJECTIVES: This study used Andersen's predisposing, enabling and need behavioural model to predict factors that influence utilisation of oral health services for children in Saudi Arabia. METHODS: The model was tested in a random sample of parents of third- and eighth-grade children in Jeddah (n = 1,668) using the access to care questionnaire adapted from the Basic Screening Survey. Predisposing (sex, parent education, nationality); enabling (school type, family income, government financial support, health insurance); and need for dental care (examined or perceived) were modelled to assess children's use of dental services. Univariate and multivariate logistic regression models were conducted. Significant findings were reported at P ≤ 0.05. RESULTS: About 84% of parents responded to our questionnaire (n = 1,397). One in four children have never visited a dentist. Our findings indicate that need and predisposing factors explained oral health services' use among younger children, whereas need, predisposing and enabling factors predicted use of services among older children. Perceived barriers to dental care for children who never went to a dentist and for those who needed dental care and could not get it included oral health illiteracy (82.3%, 49.7%), dentist-related (19.9%, 42.1%), financial (22.8%, 37.1%) and transportation (9.8%, 20.8%), respectively. CONCLUSIONS: The need for dental care, predominantly for illness-related dental care, drives utilisation of dental health services among children in Saudi Arabia. Enhancing oral health literacy and mitigating organisational and financial barriers to dental care for families will increase children's access to quality oral healthcare, and promote better oral health practices and outcomes.

Effect of Family Income on the Relationship Between Parental Education and Sealant Prevalence, National Health and Nutrition Examination Survey, 2005-2010.

INTRODUCTION: We examined the association between sealant prevalence and parental education for different levels of family income, controlling for other covariates. METHODS: We combined data from 2005-2006, 2007-2008, and 2009-2010 cycles of the National Health and Nutrition Examination Survey. The study sample was 7,090 participants aged 6 to 19 years. Explanatory variables, chosen on the basis of Andersen and Aday's framework of health care utilization, were predisposing variables - child's age, sex, race/ethnicity, and parental education (high school diploma); enabling variables - family income (<100% of the federal poverty level [FPL]; 100%-200% of the FPL; and >200% of the FPL), health insurance status, and regular source of medical care; and a need variable - future need for care (perceived child health status is excellent/very good, good, fair/poor). We conducted bivariate and multivariate analyses and included a term for interaction between education and income in the multivariate model. We report significant findings (P ≤ .05). RESULTS: Sealant prevalence was associated with all explanatory variables in bivariate and multivariate analyses. In bivariate analyses, higher parental education and family income were independently associated with higher sealant prevalence. In the multivariate analysis, higher parental education was associated with sealant prevalence among higher income children, but not among low-income children (<100% FPL). Sealant prevalence was higher among children with parental education greater than a high school diploma versus less than a high school diploma in families with income ≥100% FPL. CONCLUSION: Our findings suggest that income modifies the association of parental education on sealant prevalence. Recognition of this relationship may be important for health promotion efforts.

A needs assessment for a master's program in dental public health in Jeddah Saudi Arabia.

OBJECTIVES: The Faculty of Dentistry at King Abdulaziz University in Jeddah, Saudi Arabia, is planning a master's program in dental public health (DPH) to address the lack of adequate DPH professionals in the country. A needs assessment survey or situational analysis is typically recommended as the foundation of any curriculum development process. We conducted this survey to understand the level of DPH expertise existing in the country, to identify needs and gaps, and to explore perceptions in the area of DPH. METHODS: A DPH competency based survey was emailed to all onsite Saudi faculty members, all DPH practitioners in Jeddah city, and a random sample of dental interns (n = 122). The questionnaire collected information about participants' demographics, knowledge of DPH, preferred method for gaining knowledge about DPH, perceptions about a new master's program in DPH, preferred teaching and delivery methods, prerequisite education, and self-assessment of participants' own DPH competency levels. Descriptive statistics, chi-square or Fisher's exact statistics, and proportional odds ratios were calculated to analyze data. RESULTS: There was a total of 105 respondents (86.1%). About 98% had some knowledge of DPH. The most preferred method to gain knowledge on DPH was seminar series (47.6%). The most preferred methods for teaching instruction were using a "list of discussion topics" and "providing examples," and the most preferred method for delivery of coursework was "face-to-face classroom activities with online readings and assignments." The most preferred prerequisite education was having a bachelor's degree in dentistry. Most participants considered themselves as having moderate experience and basic range of knowledge of DPH practices and competencies. CONCLUSION: The survey has helped assess the participants' views on the need for a graduate program in DPH. It is a preliminary step in designing a well-structured program, which will address the needs and gaps in oral public health in the country and inform the development of course content.

The prevalence and determinants of tobacco use among adolescents in Saudi Arabia.

BACKGROUND: Adolescent tobacco use has been a serious public health issue, resulting in longer duration of tobacco use and higher nicotine dependence in adulthood. This study identified the current status of tobacco use among middle schools students in Jeddah, Saudi Arabia and the factors leading to tobacco use, to provide information on how to effectively prevent tobacco use among adolescents. METHODS: A cross-sectional survey was administered to measure the prevalence of tobacco use and profile tobacco users. School selection was stratified by region, gender, and type (public or private). Altogether, 1186 seventh- to ninth-grade students were selected. Of those, 1019 questionnaires were used for analysis. RESULTS: The mean age of the participants was 14.3 years (SD = 1.2) and boys comprised 54% of the sample. The prevalence of tobacco use among students was 9.72% with a significant difference between sexes (12.43% for boys and 6.65% for girls). Bivariate and multivariate analyses results showed that students whose families had higher income, had larger daily allowances, spent less time studying, skipped class more frequently, were less religious, spent more time out of home, drank more Coca-Cola, intended to use tobacco in the next year, and were males who were more likely to use tobacco. CONCLUSION: Prevention programs designed to reduce adolescent tobacco use need to consider these sociodemographic characteristics. Understanding the characteristics of adolescent tobacco users and the associated sociocultural context is critical for developing effective tobacco prevention programs targeted at adolescents.

Medicaid participation by private dentists in Alabama.

OBJECTIVE: The objective of this study was to examine the relationship between private dentists' attitudes toward Medicaid and Medicaid patients and their extent of Medicaid participation. METHODS: A survey was mailed to all Medicaid dentists in Alabama in 2003 (N = 518). Descriptive statistics were calculated, and multiple regression models were tested. The "dentists' extent of participation" was a measure of the percentage of Medicaid patients seen in one month. Independent variables included dentists' personal and practice characteristics; market area characteristics; and dentists' attitudes toward Medicaid and Medicaid patients. RESULTS: A total of 277 (54%) surveys was returned. Non-Caucasian dentists in group practice had a higher mean of extent of Medicaid participation than Caucasian dentists in solo practice. Moreover, compared to privately insured families, dentists had significantly higher mean of extent of Medicaid participation if they perceived Medicaid reimbursement as generous; payments being processed faster; and families as not acceptable to non-Medicaid families in the practice. CONCLUSIONS: Dentists' perceptions of Medicaid policies, such as generosity of payment and speed of processing payment, are important to ensure continued provider participation in Medicaid. Strategies to improve dentists' participation in Medicaid must be multifaceted to increase access to dental services for Medicaid children.

Access and utilization of dental services by Alabama Medicaid-enrolled children: a parent perspective.

PURPOSE: The purposes of this survey were to assess barriers to utilization of dental services among Medicaid-enrolled Alabama children and identify families who used or did not use Medicaid-covered dental services. METHODS: A random sample of 4,500 parents of Medicaid-eligible children ages 3 to 19 years was surveyed. Participants came from Medicaid enrollment data stratified by area of residence into 3 groups: (1) large urban; (2) town; and (3) rural. Univariate and multivariate analyses were conducted. RESULTS: The overall response rate was 40% (N = 1,766). Most respondents (71%) reported that their child had a dental visit in the past year. Compared to parents who had a dental visit, those who reported no visits were more likely to: (1) be non-Hispanic African American; (2) be less educated; (3) live in rural settings of Alabama; (4) have more children younger than 6 or older than 12; (5) have more children with disabling conditions; and (6) report poor perceived oral health. Respondents with no dental visits were grouped into 3 categories-those who: (1) believed they did not need dental care (46%); (2) thought dental care was hard to find (34%); and (3) tried but could not get dental care (20%). The first group had significantly less respondents with a high school or greater education, more reporting perceived good to excellent oral health, and more living in rural areas, compared to the other 2 groups. CONCLUSIONS: Families who did not use Medicaid-covered dental services include: (1) a group with high perceived need and barriers to care; and (2) a group with little perceived need. Interventions must target both groups.

Access to dental care in Alabama for children with special needs: parents' perspectives.

BACKGROUND: Access to dental care and delivery of quality dental health services are important for children with special needs. The authors surveyed parents of children with special needs in Alabama to determine their perceptions of access and barriers to dental care for their children. METHODS: The authors sent a questionnaire to 2,057 parents of children aged 3 to 13 years with special needs--cleft lip and/or palate; cerebral palsy, or CP; spina bifida; or epilepsy/seizure disorders--who were listed in a database provided by Children Rehabilitation Services of Alabama. The authors conducted univariate and multivariate analyses to calculate odds ratios and 95 percent confidence intervals. RESULTS: The overall response rate was 38 percent (N = 714). Eighty-five percent of respondents reported that their children had received some form of routine dental care. However, 35 percent of respondents reported they had had problems finding dentists willing to treat their children. Among those with problems, significant barriers to dental care included their children's having Medicaid insurance, poor oral health or CP, as well as a shortage of dentists with training in the care of children with special needs. CONCLUSIONS AND PRACTICE IMPLICATIONS: While the majority of respondents said their children had access to dental care, one-third said their children had problems receiving this care. Many of these problems can be ameliorated. Increasing providers' participation in the Medicaid program and improving their knowledge about, empathy for and training in the care of children with special needs is essential in improving access to dental care for this population.