A 12-year follow up of principles learned in a pediatric dentistry Master of Public Health dual degree program applied to professional practice.

Introduction: Dental public health professionals play a critical role in preventing and controlling oral diseases. The purpose of this study was to assess the application of public health principles learned in a pediatric dentistry Master of Public Health (MPH) dual degree program to professional practice upon graduation. Methods: Semi-structured interviews were conducted with pediatric dentistry/MPH dual degree alumni who graduated from the program between 2012 and 2023. Interview questions inquired about characteristics of patient population, location of providers' clinic/organization, whether the program was worthwhile to their practice and application of principles learned in the program to their professional practice. Results: Twenty of the 22 program alumni agreed to be interviewed. All alumni thought the program was extremely worthwhile to their practice. They felt the MPH component of the program gave them the public health background and tools they needed to provide comprehensive and holistic care to their patients. Additionally, all alumni reported applying the public health principles they learned in the program to their professional practice through leadership roles, research and teaching that focuses on oral disease prevention and the promotion of dental health. Discussion: Given the importance of a dental public health professionals' role in reducing oral health disparities at the population level, more pediatric dentistry MPH dual degree programs are urgently needed. Additionally, more research is necessary to demonstrate the effectiveness of these programs, which will be critical to helping ensure the value of a dual degree in dentistry and public health is recognized and promoted worldwide.

Theoretical and methodological approaches in designing, developing, and delivering interventions for oral health behaviour change.

Oral health behaviour change interventions are gaining momentum on a global scale. After lagging behind other disciplines, oral health behaviour change is becoming an area of fast and important development. Theories used in medicine and healthcare more generally are now being applied to oral health behaviour change with varying results. Despite the importance of using theories when designing and developing interventions, the variety and variation of theories available to choose from create a series of dilemmas and potential hazards. Some theories, like the COM-B (Capability, Opportunity, Motivation-Behaviour) model, and frameworks, like the Behaviour Change Wheel might represent areas of opportunity for oral health behaviour change interventions with careful consideration vital. Different methodological approaches to intervention development are actively utilized in oral health with a wide host of potential opportunities. The issue of co-designing and co-developing interventions with intended users and stakeholders from the start is an important component for successful and effective interventions, one that oral health behaviour change interventions need to consistently implement. Oral health behaviour change interventions are utilizing technology-based approaches as a major vehicle for intervention delivery and, innovative solutions are implemented across a wide host of oral health behaviour change interventions. With multiple options for designing, developing, and delivering interventions, careful selection of appropriate, user-inclusive, and adaptable approaches is essential. With a lot of available information and evidence from other disciplines, oral health behaviour change interventions need to reflect on lessons learned in other fields whilst also maximizing the potential of the wide variety of theories, frameworks, methodologies, and techniques available at present.

Effect of a Text-Messaging Intervention on Oral Self-Care Practices in Antenatal Women in Delhi, India: A Pilot Randomized Control Trial.

Objective: This study aimed to determine the effect of a mHealth (text message) intervention compared with a structured health educational session on the oral care and hygiene practices of pregnant women. Materials and Methods: We conducted a pilot randomized control trial, parallel design superiority trial, with a 1:1 allocation ratio. A total of 76 pregnant women up to 20 weeks of gestational age and capable of reading mobile phone text messages were recruited during August-October 2020 from the antenatal clinic of a primary health center in a low-income urban agglomeration in Delhi, India. The mHealth intervention arm participants were sent a daily text message for 30 days, while all participants were provided a one-time, face-face, brief didactic structured educational session toward oral health promotion. Results: The baseline characteristics of both groups were comparable in terms of age structure, education, parity, and oral hygiene but differed in terms of oral health problems. Postintervention, although the twice-brushing frequency increased in both arms, only the mHealth arm revealed a statistically significant reduction in the incidence of missed twice-daily brushing episodes (P = 0.016). Conclusions: A mHealth-based daily text-message intervention for 1 month was not superior to a one-time brief didactic structured educational intervention for oral health promotion in antenatal women.

Dynamics in oral health-related factors of Indigenous Australian children: A network analysis of a randomized controlled trial.

OBJECTIVES: Network analysis is an innovative, analytic approach that enables visual representation of variables as nodes and their corresponding statistical associations as edges. It also provides a new way of framing oral health-related questions as complex systems of variables. We aimed to generate networks of oral health variables using epidemiological data of Indigenous children, and to compare network structures of oral health variables among participants who received immediate or delayed delivery of an oral health intervention. METHODS: Epidemiological data from 448 mother-child dyads enrolled in a randomized controlled trial of dental caries prevention in South Australia, Australia, were obtained. Networks were estimated with nodes representing study variables and edges representing partial correlation coefficients between variables. Data included dental caries, impact on quality of life, self-rated general health, self-rated oral health, dental service utilization, knowledge of oral health, fatalism and self-efficacy in three time points. Communities of nodes, centrality, clustering coefficient and network stability were estimated. RESULTS: The oral health intervention interacted with the network through self-rated general health and knowledge of oral health. Networks depicting groups shortly after receiving the intervention presented higher clustering coefficients and a similar arrangement of nodes. Networks tended to return to a preintervention state. CONCLUSION: The intervention resulted in increased connectivity and changes in the structure of communities of variables in both intervention groups. Our findings contribute to elucidating dynamics between variables depicting oral health networks over time.

INCONCLUSIVE EVIDENCE INDICATES COMMUNITY BASED COMPREHENSIVE ORAL HEALTH INTERVENTION IMPROVES ORAL HEALTH STATUS COMPARED TO ONLY ORAL HEALTH EDUCATION.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Tsai C, Raphael S, Agnew C, McDonald G, Irving M. Health promotion interventions to improve oral health of adolescents: A systematic review and meta-analysis. Community Dent Oral Epidemiol. 2020 Dec;48(6):549-560. doi: 10.1111/cdoe.12567. Epub 2020 Aug 7. PMID: 32767825. SOURCE OF FUNDING: Information not available TYPE OF STUDY/DESIGN: Systematic review with meta-analysis.

Health promotion interventions to improve oral health of adolescents: A systematic review and meta-analysis.

OBJECTIVES: To evaluate the effectiveness of health promotion interventions on oral health knowledge, behaviour and status of healthy adolescents. METHODS: This review included randomized controlled trials (RCTs) of oral health promotion interventions targeting adolescents. Primary clinical outcomes (gingival health, plaque scores, caries) and secondary proxy outcomes were evaluated. Meta-analysis of primary outcomes was conducted where possible, with subgroup analysis based on intervention (comprehensive health promotion and education-only). RESULTS: Thirty-seven eligible publications reporting on 28 unique RCTs of oral health promotion interventions were included. Quality appraisal of studies ranged from 48% to 96%. Interventions reported ranged from single-session interventions to community-wide programmes, including clinical preventive procedures and take-home products. Half used a health behaviour change theory to inform their intervention. The meta-analysis pooling of results favoured the intervention over control for all clinical outcomes, except DMFS in the education-only subgroup. Stronger intervention effects were seen in the comprehensive intervention subgroup than the education-only subgroup for DMFS (P = .02). This effect was slight, but not as clear in all other clinical categories. The majority of studies reported improvements in oral health knowledge, attitudes and behaviours. More positive outcomes were found with longer programmes, especially for dental caries outcomes. CONCLUSIONS: Oral health promotion programmes targeting adolescents have the ability to improve clinical oral health outcomes in the short and long term. Programmes should use more behavioural theory-based interactive and strategic methods, including self-awareness and the use of the wider community and peers for oral health promotion activities over a longer intervention duration.

Does public transportation reduce inequalities in access to dental care among older adults? Japan Gerontological Evaluation Study.

OBJECTIVES: Income inequalities in access to dental care have been reported worldwide. While geographical accessibility may affect inequalities, no study has examined whether the use of public transportation reduces income inequalities in access to dental care. Therefore, we examined whether the use of public transportation is associated with reduced income inequalities in access to dental care. METHODS: This cross-sectional study used data from the Japan Gerontological Evaluation Study conducted in 2016. Self-reported questionnaires were distributed to 34 567 community-dwelling independent older adults aged 65 years or over from 39 municipalities. The dependent variable was dental attendance for any treatment. The independent variables were daily public transportation use and household equivalent income. The covariates were age, years of education, marital status, self-rated health, number of teeth, car use, having bus stops or railway stations nearby for individual level and density of dental clinics for community level. After multiple imputation, a two-level linear regression analysis was performed and stratified by sex. RESULTS: The mean age of the 19 664 participants (response rate: 69.9%) was 73.8 years (standard deviation = 6.1). Among the participants with dental attendance for treatment in the past six months, daily public transportation users represented 45.5% of men and 56.1% of women. These users had higher levels of dental attendance for treatment (ß = .109, 95% confidence interval (CI) = 0.051-0.166 for men, ß = .094, 95% CI = 0.039-0.149 for women) than nondaily users. Household equivalent income was positively associated with higher dental attendance for treatment (ß = .046, 95% CI = 0.029-0.062 for men, ß = .029, 95% CI = 0.013-0.045 for women). Income inequalities in access to dental care were smaller among the daily public transportation users than in nondaily users, and a statistically significant interaction was observed only in men (P-value interactions = .025 for men, .188 for women). CONCLUSION: Income inequalities in access to dental care were smaller among older daily users of public transportation than in nondaily users. These results suggest that providing environment in which people can conveniently use public transportation is needed for reducing income inequalities in access to dental care, especially for men.

Effectiveness evaluation of Contra Caries Oral Health Education Program for improving Spanish-speaking parents' preventive oral health knowledge and behaviors for their young children.

OBJECTIVES: To determine the effectiveness of the Contra Caries Oral Health Education Program (CCOHEP) for improving low-income, Spanish-speaking parents' oral health knowledge and behaviors for their young children. Mexican American children in the United States suffer disproportionately high prevalence and severity of early childhood caries, yet few evaluated, theory-based behavioral interventions exist for this population. CCOHEP is a theory-based curriculum consisting of four 2-h interactive classes designed for and by Spanish speakers and led by designated community health educators (promotoras). Topics included children's oral hygiene, caries etiology, dental procedures, nutrition, child behavior management, and parent skill-building activities. METHODS: Low-income Spanish-speaking parents/caregivers of children aged 0-5 years were recruited through community services in an agricultural city in California. Survey questions from the Oral Health Basic Research Facts Questionnaire measuring oral health-related behaviors and knowledge were verbally administered before, immediately after, and 3 months after attendance at CCOHEP. Five questions measured aspects of parental toothbrushing for their children (frequency, using fluoridated toothpaste, brushing before bed, not drinking or eating after nighttime brushing, adult assistance), three questions measured other oral health behaviors, and 16 questions measured oral health-related knowledge. Analyses of within-person changes between pre- and post-tests and again between post-test and 3-month follow-up consisted of McNemar's test for binary outcomes and sign tests for ordinal outcomes. RESULTS: Overall, 105 caregivers participated in CCOHEP (n = 105 pretest, n = 95 post-test, n = 79 second post-test). At baseline, all parents self-reported doing at least one aspect of toothbrushing correctly, but only 13% reported performing all five aspects according to professional guidelines. At post-test, 44% of parents reported completing all aspects of toothbrushing according to professional guidelines (P < .001). Statistically significant improvements were seen in 4 aspects of toothbrushing (P ≤ .008) between pretest and post-test (all but adult assistance). The second post-test showed 3 of these improvements were maintained, while adult assistance and the other reported behaviors improved (P ≤ .008). Between pretest and post-test, checking child's teeth monthly and frequency of sweet drinks consumption improved (P ≤ .008), while frequency of eating sweet foods did not change. Knowledge was high at baseline (mean 12.8 of 16), but 6 knowledge items improved significantly between pretest and post-test. Improvements were maintained at second post-test. CONCLUSIONS: Contra Caries Oral Health Education Program improved low-income Spanish-speaking parents' oral hygiene knowledge and self-reported behaviors for their young children, and change was sustained 3 months after the end of the intervention. Future, more rigorous evaluation of the intervention is recommended.

Oral health promotion interventions during pregnancy: a systematic review.

OBJECTIVES: Maternal oral disease during pregnancy is a significant public health issue due to its prevalence and lifecourse connections with adverse pregnancy/birth outcomes, early childhood caries, and chronic diseases. Although both medical and dental professional organizations have discipline-specific and co-endorsed guidelines, whether interventions exist that translate oral health evidence into practice remains unknown. Thus, we conducted a systematic review to examine the range, scope and impact of existing oral health promotion interventions during pregnancy. METHODS: Search terms related to oral health, health promotion, and pregnancy produced 7754 articles published before March 2013 from five search engines. INCLUSION CRITERIA: (i) intervention-based; (ii) quasi-experimental, experimental, or pretest/post-test design; (iii) pregnant women participants; (iv) outcomes including oral health knowledge, attitudes, and/or behaviors; (v) ≥5 participants; (vi) peer-review publication; and (vii) English language. RESULTS: All interventions (n = 7) were delivered in prenatal care settings and focused on education. Modalities varied, including the use of oral instruction and audiovisual presentations, in both individual and group formats; however, content was directed toward infant oral health. Few studies specifically addressed prenatal oral health guidelines. Primary outcomes measured included knowledge, beliefs, attitudes, self-efficacy and oral hygiene, and health-seeking behaviors. All but one study showed significant improvement in one of these outcomes postintervention. CONCLUSIONS: Few oral health interventions among pregnant women addressed oral-related symptoms, hygiene behaviors, and potential oral-systemic implications specific to mothers. Subsequently, more theory- and evidence-based interventions addressing current prenatal oral health guidelines using rigorous designs are needed to improve oral and systemic health for both women and their offspring.

Self-reported changes in using fluoride toothpaste among older adults in Sweden: an intervention study.

OBJECTIVE: The aim of the study was to investigate the possibility of increasing knowledge about the caries-reducing effects of fluoride (F) toothpaste and to increase the use of F toothpaste among older adults through an intervention. MATERIALS AND METHODS: 63-67-year-olds in Sweden, who 2 years earlier had answered a questionnaire about their knowledge of F toothpaste, toothbrushing and toothpaste habits and who had shown less favourable habits with regard to toothpaste use, were invited to participate. The 20-min intervention, performed at a Public Dental Clinic, was implemented by a dental hygienist (author OJ) and consisted of individual information and instruction on the use of F toothpaste. The questionnaire was repeated 4 months after the intervention and a population in another city in Sweden served as control. RESULTS: In the intervention group, 68 individuals responded and 151 in the control group. Knowledge of the benefits of F toothpaste in the intervention group had improved between the times of the first and second questionnaires, but the same effect was also noted in the control group. After the intervention, a clear improvement concerning the use of F toothpaste was reported: the individuals brushed for a longer time, used more toothpaste and used less water during and after brushing. In the control group, there were no changes of habits between the first and second occasions. CONCLUSION: Individually-based interventions performed by a dental hygienist had a positive effect on changing the way older adults used F toothpaste.

Impact of lifestyle factors on caries experience in three different age groups: 9, 15, and 21-year-olds.

OBJECTIVES: To study the impact of lifestyle factors on dental caries experiences in addition to the effect of demographic characteristics at the ages of 9, 15, and 21 years. METHODS: The data were obtained from the study 'Oral health in children and adolescents in the Netherlands'. Data were collected through questionnaires and a clinical oral examination. Because the DMFS count data were highly skewed with a peak at zero, the negative binomial hurdle model was used for the analyses. The first part of the hurdle predicted the probability of having caries experience or not, and the second part predicted the degree of caries experience. RESULTS: For the 9- and 15-year-old age groups, the breakfast frequency per week was related with having caries experience, while the frequency of brushing teeth per day was related with the degree of caries experience. In addition, the number of food and drinks consumed per day was important for the younger age group. These relations were not found in the 21-year-olds age group. CONCLUSIONS: Findings of this study suggest that components to promote structure and regularity, including having breakfast and the number of food and drink moments, may be important to include in programs to prevent dental caries in children.

Evaluation of an oral health promotion program at the time of birth on dental caries in 5-year-old children in Vorarlberg, Austria.

OBJECTIVES: The aim of this study was to evaluate the effect of an early oral health promotion program (OHPP) on oral health of 5-year-old children in Austria by providing new mothers with dental health counseling. METHODS: Qualified dental health educators visited all mothers at time after birth in regional hospitals in Vorarlberg and counseled them regarding the oral health of their children as a one-off intervention. Mothers were given comprehensive oral hygiene instructions for their children and themselves (daily use of fluoride toothpaste, restoration of own caries lesions), which included practical tooth brush training and dietary counseling by the use of brief motivational interviewing and anticipatory guidance approaches. After 5 years, a case-cohort study was conducted to evaluate the program with annual dental check-ups of 471 children and a parent survey. Dental caries was scored using WHO diagnostic criteria at dentine level without radiography. To compare oral health parameters (dmfs/dmft, care index), children were allocated to intervention and control group and matched on basis of age, sex, ethnicity, and socio-economic status (SES) and analyzed statistically. RESULTS: Children whose mothers participated in the OHPP showed significantly lower caries prevalence and experience (33.2%; 3.2 ± 7.4 d3-4 mfs/1.5 ± 2.5 d3-4 mft) than children whose mothers did not participate (42.6%; 5.2 ± 6.4 d3-4 mfs/2.4 ± 4.1 d3-4 mft). Bivariate analysis showed that ethnicity, SES, age at which toothbrushing started, supervision of toothbrushing, use of fluoride salt, and use of fluoride toothpaste were significantly related to d3-4 mft. CONCLUSIONS: The OHPP was an effective community-based preventive approach for improving oral health in preschool children.

Dentist-specific variation in diagnosis of caries - a multilevel analysis.

BACKGROUND: There are few studies on practice variation within dentistry. This contrasts with medicine where numerous studies exist. A major finding from the field of medicine is that the size of the physician-specific effects depends on the degree of uncertainty in diagnosis. The physician-specific effects are small for diseases where the diagnostic criteria are unambiguous. Conversely, the effects are large for diseases where the diagnostic criteria are less unambiguous. OBJECTIVES: To assess the size of provider-specific variation in the diagnosis of caries among children and adolescents in Norway and to determine whether this variation depends on uncertainty in diagnosis. METHODS: Data on caries diagnosis for 709 611 children and adolescents aged 6-18 years were analysed using multilevel regression. Level-1 was patients and level-2 was public dental officers and dental hygienists. Caries was measured according to the following localization of the lesion: in the outer half of the enamel, in the inner half of the enamel, in the outer third of the dentine, in the middle and inner third of the dentine, to the pulp. The degree of uncertainty in diagnosis is expected to be least the deeper into the dentine the lesion goes. Our sample included 87.5% of all individuals aged 6-18 years. RESULTS: The provider-specific variation, measured as the intraclass correlation coefficient, ranged from 15% for caries lesions localized in the outer half of the enamel to 2% for caries to the pulp. CONCLUSIONS: The size of provider-specific variation in the diagnosis of caries is fairly low. The size of the variability is dependent on the level of diagnostic uncertainty, which is coherent with the practice style hypothesis.

Regular dental checkup and snack-soda drink consumption of preschool children are associated with early childhood caries in Korean caregiver/preschool children dyads.

OBJECTIVES: Early childhood caries (ECC) is a common oral disease among young Korean children. The purpose of this study was to examine the relationship of ECC with preschool children's oral health behavior and caregivers' oral health in Ulsan, Korea. METHODS: In 2006, cross-sectional survey of 1214 children under 6 years old and their care givers were surveyed. Two dentists examined according to the WHO criteria. Outcome variable was ECC, and explanatory variables were preschool children's oral health behavior and caregivers' oral health. The chi-square test and multiple log-binomial regression models were performed. RESULTS: The prevalence of simple ECC was 47.5% and that of severe ECC was 34.8%. In bivariate analysis, ECC prevalence was increased according to children's age, caregiver's age, and type of housing. In multiple log-binomial regression models, preschool children's irregular oral checkup [prevalence ratio (PR): 1.7 for simple ECC and 1.8 for severe ECC] and frequent snack and soda drinking (PR: 1.2 for simple ECC, and 1.6 for severe ECC) were significant factors. CONCLUSIONS: This study demonstrates that the prevalence of ECC was high among Korean children. Early intervention programs for preschool children's oral health behavior should be developed based on the risk factors identified in this study.

Jardín Infantil de la Universidad Nacional de Colombia: evaluación de un programa para la promoción de salud bucal en la primera infancia / Kindergarten of the National University of Colombia: evaluation of a health promotion program for the early childhood

Antecedentes: la caries en la primera infancia es considerada un problema de salud públicaen muchos países. En Colombia, el 60,44 % de los niños a los cinco años tiene historia decaries. En el Jardín Infantil, la Facultad de Odontología realizó intervenciones de promociónde salud bucal en las últimas tres décadas, enmarcadas en programas académicos.Métodos: se realizó un estudio descriptivo transversal. La investigadora aplicó encuestasa los cuidadores y examinó clínicamente a 118 niños de los 150 matriculados. Resultados:el ceo-d de los niños valorados del jardín corresponde a un 0,805 que, según la OMS, estácatalogado como muy bajo. En una valoración en el 2005 se encontró un 36,06 % de niñosenfermos con caries cavitacionales contra el 14,4 % de niños con presencia de caries activascavitadas y no cavitadas. Esto demuestra mejores condiciones de salud bucal, si se comparacon el 54,4 % de niños que presentan caries a los cinco años en el ámbito nacional y el 59,3 %de niños en las mismas condiciones en Bogotá. En cuanto a educación para la salud, losresultados de las encuestas revelan que el 80 % de los cuidadores de los niños tienen unasuficiencia conceptual que les permite brindar cuidados y promover conductas para prevenirenfermedades bucales. Conclusión: en Colombia la caries de infancia temprana requiereun abordaje con programas basados en adquisición de hábitos saludables mediados poreducación con énfasis en nutrición e higiene desde antes del nacimiento y con alianzasestratégicas con escuela saludable y empresas promotoras de salud...

Background: Early childhood cavities are considered a public health problem in manycountries. In Colombia, 60.44 % children age five have a history of cavities. Since 1980, theDental School has implemented dental health promotion interventions in the kindergarten.Methods: A descriptive study was carried out. The researcher administered surveys to thecaregivers and examined 118 children out of the 150 enrolled. Results: dmf-t Index of thechildren assessed in the kindergarden was 0.805, which, according to the WHO standards,is considered very low. A study in 2005 showed that 36.06 % children suffered from cavitationalcaries, compared to 14.4 % children with active cavitated and non-cavitated caries.This shows a better dental health status when compared with 54.4 % five-year-old childrenwith dental cavities nationwide and 59.3 % children under the same conditions in Bogotá.Regarding health education, the surveys show that 80 % caregivers possess conceptualsufficiency to provide dental care and promote disease preventive habits. Conclusion: InColombia, early childhood caries should be considered a public health problem and it isnecessary to emphasize promotion and prevention programs based on the acquisition ofhealthy habits mediated by education with an emphasis on nutrition and hygiene from birth,in order to implement these strategies in schools...