Health-Promoting Schools Project for Palestine Children's Oral Health.

OBJECTIVES: The aim of this work was to assess the oral health outcome of a 2-year comprehensive school oral health programme based on school-health education combined with supervised toothbrushing using 1450-ppm fluoride toothpaste amongst schoolchildren in Palestine. METHODS: A quasi-experimental study (2016-2018) recruited 3939 schoolchildren aged 5 to 6 years from 30 intervention schools (n = 2333) and 31 comparison schools (n = 1606). At baseline and postintervention, mothers and schoolteachers completed World Health Organization (WHO) self-administered questionnaires about oral health of children, oral health behaviour, and family factors. Of the initial participants 75.8 per cent took part in the follow up studies. In addition, 25 calibrated dentists examined dental caries of children according to WHO criteria. Trained teachers provided comprehensive oral health education to children in the classrooms and held regular oral health sessions for mothers. Children brushed their teeth with fluoride-containing toothpaste (1450 ppm fluoride). Student t-test and logistic regression were used in the statistical analysis of changes in dental health and related knowledge, behaviours, and attitudes (P < .05). RESULTS: In both dentitions, dental caries experience declined over the project. The reduction in Decayed, Missing and Filled permanent Teeth and Decayed, Missing and Filled Surfaces in permanent teeth was 23.3% and 23.2% (P < .001), respectively. The drop in caries experience indices in the Gaza Strip was 8 to 4 times higher than in West Bank, and it reached 47.4% reduction. Mothers and teachers showed improvement in positive knowledge and attitudes towards dental care. Involvement of schoolteachers in oral health in schools and acceptance of dental health education materials significantly enhanced oral health behaviour of children. CONCLUSIONS: The project recommends national implementation of an intervention for the improvement of oral health of schoolchildren and their parents in conflict zones. The project shows the importance of the WHO Health Promoting Schools concept and involving classroom-based health education carried out by schoolteachers. It is suggested to explore the health care system's capacity in hosting effective oral health programme and maintain its efficacy.

Schoolteachers for Action Against HIV/AIDS-related Oral Disease of Children in Africa.

PURPOSE: The intention of the study was to evaluate whether Sub-Saharan schoolteachers may play a key role in oral health promotion of primary schoolchildren, particularly in terms of prevention of HIV/AIDS-related oral health problems. MATERIALS AND METHODS: The study examined the level of knowledge about oral disease and the prevention of HIV/AIDS oral lesions amongst schoolteachers of Tanzania and Burkina Faso, identified their sources of information, and evaluated their ability for HIV/AIDS intervention. A multi-centre cross-sectional study was implemented in the two Sub-Saharan African countries. Participants comprised primary school teachers selected by stratified cluster sampling: 261 teachers from Tanzania and 313 teachers from Burkina Faso. All participants completed a structured questionnaire prepared for self-administration. The questions were designed from a standardised questionnaire developed by the World Health Organization. RESULTS: Most teachers knew about the principal causes of the major oral diseases and the means of disease prevention. Nearly all teachers (95.6%) were aware of HIV/AIDS and they knew (92.3%) a virus was the direct cause of AIDS. Teachers were well informed of the general symptoms of HIV/AIDS, although oral symptoms were mentioned less often. In all, 17.6% of schoolteachers reported that children suffering from HIV/AIDS were found in their classes and 10.3% of teachers were conscious of students receiving anti-retroviral therapy (ART). Knowledge about the disease seemed to reflect mass media as a source, while teacher colleagues and health personnel played a somewhat lesser role in communication. In total, 83.2% emphasised that they should teach children about HIV/AIDS and the mouth. Schoolteachers from Tanzania (70.5%) were more often engaged in classroom-based oral health education than were the Burkinabe teachers (53.9%). CONCLUSION: The study confirms that schoolteachers may be a relevant source in the fight against HIV/AIDS among children. However, they would benefit from interaction with health personnel.

Improving oral health of children in four Balkan countries: A qualitative study among health professionals.

Data from the WHO show that the oral health situation for children in the Balkan region of Europe is poor. This study aims to identify obstacles that prevent the implementation of an effective oral health program for children in the Balkan area. The study investigates the challenges that people encounter in increasing awareness, attending to dental care, and complying with examinations. Methods: This qualitative study targeted experts in preventive dentistry and oral health promotion in four countries in the Balkan region. Purposive sampling was used to recruit the participants. Data were collected in 2021 using individual in-depth interviews with participants from Albania, Bosnia and Herzegovina, Croatia, and Serbia. The study applied the thematic analysis method. Results: The experts reported four main challenges that hindered the implementation of a prevention program and regular patient attendance: (1) lack of knowledge, (2) the exclusion of oral health from overall health, (3) organization of services, and (4) skepticism of fluoride. The participants identified knowledge gaps among the general population, dental staff, and other health professionals regarding the prevention of oral diseases. Conclusion: The findings of this study may be used to promote and improve oral health among children in the identified areas and to benefit people in the region and elsewhere. This study sheds light on the existing barriers in a region where people lack information.

Oral Health Status and Oral Health Behaviour among 5- to 6-year-old Palestinian Schoolchildren - Towards Engagement of Parents and Schoolteachers for Oral Health through Schools.

PURPOSE: 1. To assess the oral health status and health behaviour of 5- to 6-year-oldchildren and the influence of socio-behavioural factors on oral health among children, and 2. evaluate dental knowledge and attitudes related to oral health promotion of children among mothers and schoolteachers in Palestine. MATERIALS AND METHODS: This cross-sectional survey was carried out in 2017, and recruited samples of children (n = 3939, 53.8% boys, 44.8% girls) from 61 primary schools, their mothers and schoolteachers (n = 53). Participants were selected randomly by multistage stratified cluster sampling. Calibrated dentists performed oral examinations of 5- to 6-year-old schoolchildren based on WHO criteria. Mothers and teachers completed WHO self-administrated questionnaires to assess children's oral health behaviour, as well as their knowledge and attitudes towards children's dental care. RESULTS: Caries prevalence of primary teeth was 83.4% and caries experience was high (dmf-s = 11.17). One-fourth of children suffered from pain or discomfort from teeth, and 57.7% of children had seen a dentist within the past 12 months, frequently due to pain or problems. Consumption of sugars was frequent and only 19.7% brushed their teeth every day. Neglect of dental visits, infrequent toothbrushing, being a child from families of urban settings and high socioeconomic status were greatly affected by caries. Mothers and schoolteachers had mostly positive attitudes towards school-based oral health care. However, the availability of dental health education materials was extremely low. CONCLUSION: The establishment of school-based oral health programmes, including effective use of toothpaste containing fluoride for caries prevention, is greatly needed to improve the oral health of Palestinian children. The introduction of fluoridated school milk is highly recommended. The establishement of school programmes should encompass active involvement of schoolteachers and mothers to promote the development of healthy lifestyles and sustainable oral health behaviours among schoolchildren. Provision of materials for health education by schoolteachers and mothers is urgently needed.

Trends in dentate status and preventive dental visits of the adult population in Denmark over 30 years (1987-2017).

This study analyzed the trend in self-reported dentate status over 30 years (1987-2017) among Danish adults, the self-reported frequencies of preventive dental visits undertaken annually during the period 1987-2013, and the self-reported use of the 2016 recall scheme for preventive dental check-ups. The impact of social determinants (education, employment, civil status, and ethnic background) on these dental outcome variables in 2017 was explored. Questionnaire data were obtained from the Danish Health and Morbidity Surveys conducted from 1987-2017, and they were analyzed by tri-variate frequency distributions and multivariate analyses. The prevalence of complete tooth loss was 17.7% in 1987 but 3.4% in 2017. The frequency of adults having 20 or more teeth grew markedly from 1987 (65.9%) to 2017 (85.1%). Educational inequality in dentate status persisted over the period. The frequency of preventive dental visits at least annually increased from 1987 to 2013, although visits were less frequent for young people. In 2017, preventive dental check-ups were reported in intervals: less than 12 months (56.4%), 12-18 months (18.9%), 19-24 months (4.8%), and more than 24 months (5.2%). In 2017, dentate status and preventive dental check-ups varied profoundly by social determinants. In conclusion, social policies should be implemented to tackle the persistent inequities in dentate status and public health policies should target Universal Health Coverage.

Global application of oral disease prevention and health promotion as measured 10 years after the 2007 World Health Assembly statement on oral health.

OBJECTIVES: The WHO World Health Assembly established in 2007 a Resolution (WHA60.17) on oral health, which called upon countries to ensure that public health actions for disease prevention and health promotion are established. The objective of the present survey undertaken 10 years later (2017-2018) was to measure the application of such programmes for key population age groups in low-, middle- and high-income countries. METHODS: Oral health focal points of ministries of health worldwide (n = 101) answered a structured questionnaire on existing national oral health systems and the actual public health activities. The response rate was 58.4%. The questionnaire was used to collect information about structural factors, country workforce, financial models, provision of preventive services and promotion for oral health, school health programmes, administration of fluoride, national oral health targets and oral health surveillance. The countries were classified by national income for analysis of data. RESULTS: Coverage of population groups by primary oral health care and emergency care varied by national income. The gap between countries in delivery of preventive care was strong since low-income countries less often reported preventive activities than middle-income countries and particularly when compared to high-income countries. School oral health programmes were less frequent in low-income than other countries. Moreover, population methods of fluoridation and use of fluoridated toothpaste were unusual in low-income countries. Health education, mass communication and community events were often essential elements in health promotion. In disease prevention, many countries considered the link between oral health and general health conditions and intervention towards shared risk factors of NCDs. The health concern for the consumption of tobacco, unhealthy diet and sugars was particularly emphasized by high-income countries but less highlighted by low-income countries. Finally, while national oral health targets for children and surveillance systems were frequently reported by countries, similar systems for adolescents, adults and older people were rare. CONCLUSIONS: The inequities between countries in oral disease prevention and health promotion were substantial. Limited financial resources for preventive care and health promotion; inadequate workforce for oral health, and insufficient coverage in primary health care were observed in low-resource countries. The results of the survey demonstrate the need for building effective oral health systems oriented towards oral disease prevention and health promotion.

Changing Levels of Dental Caries over 30 Years among Children in a Country of Central and Eastern Europe - The Case of Hungary.

PURPOSE: Improved oral health of children is noted in most Western countries, but this coincides with a high burden of oral disease in several countries of Central and Eastern Europe. The purpose of the present study was to describe the current level of dental caries in Hungarian children aged 5, 6, and 12 years and to assess the long-term trends in caries over 30 years. In addition, the report aims to highlight the oral health habits of 12-year-old children in Hungary. MATERIALS AND METHODS: A representative survey was undertaken in 2016-2017 according to the WHO Pathfinder methodology, which was also applied in previous national oral health surveys of 1985, 1991, 1996, 2001, and 2008. Children of 5-6 and 12 years were sampled systematically in all surveys over 30 years. Data were gathered through clinical examinations and a questionnaire used for 12-year-olds. RESULTS: In 2016-2017, 42.6% of 5- to 6-year-olds were caries free, with the proportion lower in rural than urban settings. Approximately four primary teeth were affected by caries among children aged 5-6 years. Most of the disease burden consisted of untreated caries. Caries experience was higher for children living in rural areas. At age 12, about two permanent teeth suffered from caries, and the D-component of the caries index was high. The percentage of caries-free 6-year-olds grew from 9% in 1985 to 42.6% in 2016-2017. In 1985, 12-year-olds had on average 5 teeth affected by caries, and after 30 years, the level of caries declined to 2.3 DMFT in 2016-2017. The responses to the questionnaire showed that 11.9% of 12-year-olds visited the dentist because of oral pain or discomfort and 40.5% were dissatisfied by the appearance of their teeth. About 40% of children consumed soft drinks or sweets/candy, several times a day. CONCLUSIONS: Hungary has not yet achieved the WHO goals for children aged 5-6. While Hungary accomplished the WHO goal for oral health of 12-year-olds by the year 2000, it is seems unrealistic for the country to achieve the WHO goal for 12-year-olds by the year 2020. For better oral health of children, strong emphasis should be given to population-directed oral disease prevention, including the reduction of sugar consumption and implementing public health programmes for the effective use of fluoride.

Epidemiology of Dental Caries and Disease Prevention Among 12-Year-Olds in Slovenia Over Thirty Years (1987-2017).

PURPOSE: The first large-scale epidemiological survey on dental caries in Slovenia was conducted in 1987 and repeated in 1993, 1998, 2003, 2008, 2013 and 2017, using the same methodology. The aim of the study was to examine the trend of caries in 12-year-olds in Slovenia during a 30-year time period. The changes over time in caries experience were compared with disease trends observed in other European countries. Study Populations and Methods: The WHO National Oral Health Pathfinder Survey was applied in all seven surveys (1987-2017). The surveys were carried out in all nine geographical regions of Slovenia. For each subject, the caries experience and presence of sealants were recorded. RESULTS: The mean DMFT of 12-year-olds decreased significantly from 5.1 in 1987 to 1.5 in 2017 (p < 0.0001). The percentage of persons with sealed teeth increased from 6% in 1987 to 94% in 2017, and the percentage of caries-free persons increased from 6% to 42%. CONCLUSION: The implementation of a nation-wide preventive programme was determined to significantly contribute to the effective control of caries and continuously improve the oral health of Slovenian children. In an international perspective, the Slovenian achievements in disease prevention in terms of caries prevalence reduction may be important for other countries of the region.

'MI' reflections on a pandemic-governed 2020.

Oral/dental healthcare delivery in the post-pandemic era will be different, with challenges to overcome and positive opportunities to take. Managing the needs, wants and expectations of all stakeholders must be communicated and actioned effectively, moving forwards. It is the responsibility of all stakeholders to work together to help provide high quality, evidence-based pragmatic oral healthcare delivery for the future. Patient-focused, team-delivered, minimum intervention oral healthcare (MIOC) is applicable to all patients at all stages of their lives and underpins long-term delivery of better oral and systemic health to all. Guidance, peer-support, whole-team training along with agile commissioning and suitable incentivisation will need to support the paradigm shift to prevention-based MIOC clinical practice.

Associations of physical activity with childhood asthma, a population study based on the WHO - health behaviour in school-aged children survey.

BACKGROUND: Asthma in paediatric populations is one of the highest public health concerns. In this study of children and adolescents, we hypothesized that low levels of physical activity (PA) would show associations with asthma that vary by asthma outcome. The objective was to assess whether PA was associated with ever asthma and/or current asthma. METHODS: Analyses were based on 4824 Danish schoolchildren aged 11-15 years old (48.7% boys) participating in the HBSC survey. The study variables were (1) physician-diagnosed asthma (ever asthma) and (2) physician-diagnosed asthma plus wheezing and/or physician or hospital consultation for wheezing (current asthma). Associations with PA by gender were analysed with multivariate logistic regression using the "variance covariance (vce) cluster" method. RESULTS: The prevalence of ever asthma was 14.3% (boys) and 12.8% (girls), and that of current asthma was 6.8% (boys) and 7.0% (girls). Boys with current asthma showed important differences in low and high PA. We found inverse associations between low PA and ever asthma, odds ratio [95% confidence interval] male: .55 [.30; .99] and female: .47 [.24; .93], and current asthma, male: .27 [.12; .60] (P linear trend = .007) and female: .32 [.11; .94]. CONCLUSIONS: The lowest activity levels showed significant inverse associations with asthma, regardless of the definition. For boys, the more stringent (current asthma) of the two paediatric asthma definitions revealed a significant trend with PA, and the direction of associations shifted to positive as weekly PA increased.

Promoting Oral Health and Quality of Life of Older People - The Need for Public Health Action.

PURPOSE: This report intends to review the global burden of oral disease among older people and to examine their oral health needs. The evidence on the inter-relationships between poor oral health conditions of older people, general health and quality of life is highlighted. Finally, WHO strategies to improve oral health of older people are reviewed. METHODS: The information relevant to this review was extracted from the WHO Global Oral Health Data Bank, the PubMed database, and the Cochrane Library. Surveys were carried out according to the criteria recommended by the WHO epidemiological manual Oral Health Surveys - Basic Methods. In addition, global data were sought on coverage of oral health care among older people. Finally, WHO policy documents on health care for aged people were gathered through the WHO website. RESULTS: Across the globe, many older people suffer from oral pain or discomfort. Poor oral health during old age is mostly manifest in high caries experience, high prevalence rates of advanced periodontal disease, severe tooth loss, dry mouth, and oral pre-cancer/cancer. In both developing and developed countries, the burden of disease is particularly high among underprivileged and disadvantaged older people. In numerous countries, high proportions of the aged population are not covered by primary oral health care; this is mainly the case in low and middle income countries due to a critical shortage of dentists. CONCLUSIONS: In 2015, the WHO published the World Report on Ageing and Health, which outlines a framework for action to foster healthy ageing. The policies are highly relevant to the improvement of oral health. Transformation of oral health systems away from a disease-based curative model and towards disease prevention, as well as the provision of older-person-centred integrated care are required. Moreover, wide-ranging public health action on ageing is urgently needed.

WHO Global Consultation on Public Health Intervention against Early Childhood Caries.

Early Childhood Caries (ECC) is prevalent around the world, but in particular the disease is growing rapidly in low- and middle-income countries in parallel with changing diet and lifestyles. In many countries, ECC is often left untreated, a condition which leads to pain and adversely affects general health, growth and development, and quality of life of children, their families and their communities. Importantly, ECC is also a global public health burden, medically, socially and economically. In many countries, a substantial number of children require general anaesthesia for the treatment of caries in their primary teeth (usually extractions), and this has considerable cost and social implications. A WHO Global Consultation with oral health experts on "Public Health Intervention against Early Childhood Caries" was held on 26-28 January 2016 in Bangkok (Thailand) to identify public health solutions and to highlight their applicability to low- and middle-income countries. After a 3-day consultation, participants agreed on specific recommendations for further action. National health authorities should develop strategies and implement interventions aimed at preventing and controlling ECC. These should align with existing international initiatives such as the Sixtieth World Health Assembly Resolution WHA 60.17 Oral health: action plan for promotion and integrated disease prevention, WHO Guideline on Sugars and WHO breastfeeding recommendation. ECC prevention and control interventions should be integrated into existing primary healthcare systems. WHO public health principles must be considered when tackling the effect of social determinants in ECC. Initiatives aimed at modifying behaviour should focus on families and communities. The involvement of communities in health promotion, and population-directed and individual fluoride administration for the prevention and control of ECC is essential. Surveillance and research, including cost-effectiveness studies, should be conducted to evaluate interventions aimed at preventing ECC in different population groups.

Oral health status among children and adolescents in governmental and private schools of the Palestinian Territories.

BACKGROUND: Political conflicts in the Palestinian Territories (PT) have resulted in systematic deterioration of socio-economic conditions and health. The World Health Organization (WHO) has emphasised the negative impacts of social crisis on children' oral health and quality of life. OBJECTIVES: To assess the prevalence and trends in dental caries and poor gingival health of schoolchildren in the PT through the scholastic years 1998/1999 to 2012/2013. METHODS: This is a retrospective study. Prevalence data on dental caries of primary and permanent dentitions among children 6, 12 and 16 years of age were gathered from annual oral health reports of the School Dental Health Programme (SDHP)-Ministry of Health. Caries was recorded according to WHO methods and criteria. Decayed, missing and filled teeth indices for primary (dmft) and permanent (DMFT) teeth were calculated. Gingival health status was examined according to the Community Periodontal Index (scores 1 and 2). Statistical analysis used SPSS. RESULTS: In 2012/2013, dental caries prevalence rates and the index scores among schoolchildren were as follows, respectively: 56.4% and 2.7 dmft at age 6; 42.0% and 1.4 DMFT at age 12; and 38.7% and 1.7 DMFT at age 16. For all age groups, the d/D-component of the caries indices was high. Trends of dental-caries prevalence, caries experience and gingival bleeding were fairly constant over time from 1998/1999. CONCLUSION: The SDHP was established in order to prevent and control oral diseases among schoolchildren in the PT. The Programme is fairly passive and the survey indicates an urgent need for reorientation of activities towards population-based prevention and health promotion. The application of the WHO Health Promoting Schools concept is highly recommended.

Implications of WHO Guideline on Sugars for dental health professionals.

The burden of oral disease is high in populations across the world. This is because of high consumption of free sugars. The WHO Guideline on Sugars Intake for Adults and Children recommended limiting free sugars to no more than 5% energy intake to protect oral health throughout the life-course. The objectives of this paper are to consider the implications of the Guideline for dental health practice and to advocate use of the common risk factor approach when providing dietary advice. As part of a broad range of actions needed to reduce free sugars intake, improved education for dental health professionals and supporting patients to eat less free sugars are key actions for the dental profession. All dental health professionals should have the skills and confidence to provide their patients with healthier eating advice, including how to limit free sugars intake. It is therefore important that dental health professionals receive adequate education in diet and nutrition, and there is a need for dental educational regulating bodies to define the content of the dental curriculum with respect to nutrition. All patients, or their parents or carers, should receive dietary advice to reduce free sugars within the context of a healthy diet for the prevention of all NCDs. Dietary advice should: (i) focus on reducing the amount of free sugars consumed; (ii) be tailored according to the patient's body mass status (eg underweight, overweight, normal weight); (iii) encourage the consumption of fresh fruits and vegetables, nuts, seeds, and wholegrain starch-rich foods; (iv) discourage the consumption of foods high in saturated fat and salt; and (v) discourage the consumption of all drinks containing free sugars. The dental health professional has an opportunity to support patients to reduce their intake of free sugars-such advice and support will have positive impacts beyond the mouth.

Policy Development Fosters Collaborative Practice: The Example of the Minamata Convention on Mercury.

This article provides an example of interprofessional collaboration for policy development regarding environmental global health vis-à-vis the Minamata Convention on Mercury. It presents an overview of mercury and mercury-related environmental health issues; public policy processes and stakeholders; and specifics including organized dentistry's efforts to create global policy to restrict environmental contamination by mercury. Dentistry must participate in interprofessional collaborations and build on such experiences to be optimally placed for ongoing interprofessional policy development. Current areas requiring dental engagement for interprofessional policy development include education, disaster response, HPV vaccination, pain management, research priorities, and antibiotic resistance.

Childhood asthma and physical activity: a systematic review with meta-analysis and Graphic Appraisal Tool for Epidemiology assessment.

BACKGROUND: Childhood asthma is a global problem affecting the respiratory health of children. Physical activity (PA) plays a role in the relationship between asthma and respiratory health. We hypothesized that a low level of PA would be associated with asthma in children and adolescents. The objectives of our study were to (1) summarize the evidence available on associations between PA and asthma prevalence in children and adolescents and (2) assess the role of PA in new-onset or incident asthma among children and adolescents. METHODS: We searched Medline, the Cochrane Library, and Embase and extracted data from original articles that met the inclusion criteria. Summary odds ratios (ORs) and confidence intervals (CIs) were used to express the results of the meta-analysis (forest plot). We explored heterogeneity using funnel plots and the Graphic Appraisal Tool for Epidemiology (GATE). RESULTS: We retrieved 1,571 titles and selected 11 articles describing three cohort and eight cross-sectional studies for inclusion. A meta-analysis of the cohort studies revealed a risk of new-onset asthma in children with low PA (OR [95 % CI] 1.32 [0.95; 1.84] [random effects] and 1.35 [1.13; 1.62] [fixed effects]). Three cross-sectional studies identified significant positive associations between childhood asthma or asthma symptoms and low PA. CONCLUSIONS: Children and adolescents with low PA levels had an increased risk of new-onset asthma, and some had a higher risk of current asthma/or wheezing; however, there was some heterogeneity among the studies. This review reveals a critical need for future longitudinal assessments of low PA, its mechanisms, and its implications for incident asthma in children. The systematic review was prospectively registered at PROSPERO (registration number: CRD42014013761; available at: http://www.crd.york.ac.uk/PROSPERO [accessed: 24 March 2016]).