Mitigating Global Oral Health Inequalities: Research Training Programs in Low- and Middle-Income Countries.

Although oral diseases are largely preventable, they are among the most non-communicable diseases globally, and they disproportionately burden disadvantaged communities, specially within low- and middle-income nations. The COVID-19 pandemic has highlighted the social, economic, and health inequalities in our society, including the existing global oral health inequalities. There is a shortage of dentist-scientist all around the world, especially in developing countries, such as Thailand. The National Institute of Dental and Craniofacial Research (NIDCR) and Fogarty International Center (FIC), joined efforts on creating research capacity in oral health in South East Asia through the Fogarty International Center Training Program in Clinical, Public Health and Behavioral Oral Health Research for Thailand (2006-2016). The University of Washington (USA), Thammasat University (Thailand) and Khon Kaen University (Thailand) partnered to conduct short-, medium- and long-term training programs to build regional oral health research capabilities. Investing in research has not only impacted trainees' career development but enhanced advancement of oral health research of South East Asia. The success of partnership calls for expanding oral health research training in other low-income countries.

Saúde Bucal em tempos de pandemia

O Debate Virtual do Conass desta sexta-feira (02/10), às 16h30, irá apresentar experiências exitosas de municípios brasileiros na estruturação dos serviços de Saúde Bucal e discutir desafios e caminhos na organização dos serviços odontológicos em rede. O objetivo é apoiar profissionais e gestores na estruturação das ações e dos serviços de Saúde Bucal, buscando responder de forma efetiva à pandemia de Covid-19, o que tem sido um grande desafio. A organização do cuidado em Saúde Bucal, em todos os níveis de atenção, também é profundamente afetada nesse cenário, uma vez que uma das principais via de transmissão do vírus é a saliva e os procedimentos odontológicos, por sua natureza, apresentam elevado potencial de contaminação cruzada entre usuários e profissionais. É necessário cuidar e proteger a população e também os profissionais de saúde. O Guia Orientador para Enfrentamento da Covid-19 na Rede de Atenção à Saúde, elaborado conjuntamente pelo Conass e o Conasems, apresenta orientações para apoiar profissionais e gestores de saúde bucal da Atenção Primária à Saúde (APS) na organização do cuidado aos usuários. Este encontro virtual contará com a participação do coordenador de Saúde Bucal de Caxias, Maranhão, Thiago Henrique Gonçalves Moreira; da coordenadora de Saúde Bucal de Mairi, Bahia, Caroline Santos Figueiredo; e do facilitador da Planificação da Atenção à Saúde do Conass, Wagner Fulgêncio Elias. Os debatedores serão o assessor técnico do Conasems, Rodrigo Lacerda; e a coordenadora geral de saúde bucal do Ministério da Saúde, Caroline Martins José dos Santos. A mediação do debate será feita pela assessora técnica do Conass, Maria José Evangelista.

Self-Assessment of Psychological and Mechanical Factors Affecting Oral Hygiene Among Indian College-Going Students: A Model-Guided Study.

Good oral hygiene is the foundation for a healthy mouth. This study was aimed to determine the efficacy of oral health education based on an integrated model on oral hygiene attitude and behavior among the college students of Udaipur city. An intervention study was conducted among 156 college students in Udaipur city. The questionnaire based on the new integrated model was tested for validity and reliability. Paired t test and multinomial regression analysis were employed for statistical analysis. Significant differences were observed regarding all the indicators of oral hygiene practices, perceived susceptibility, seriousness, benefits, barriers, self-efficacy, and external locus of control. Odds ratio was significantly greater among undergraduate regarding oral hygiene practices. Also odds ratio of perceived susceptibility and seriousness was more among male population. The educational intervention was successful in conveying the message regarding the importance of oral hygiene practices.

Comparison of Two School-Based Oral Health Education Programs in 9-Year-Old Children.

This study evaluated the effectiveness of two school-based oral health education (OHE) programs on the oral health knowledge and behavior and oral hygiene of 9-year-old children in Turkey. The study included 1,053 school children aged 9 years in Aydin, Turkey. This study was a prospective, two-arm, and parallel-group clinical trial between two different OHE programs. The dentist group received one lecture on OHE given by dentists in the classroom. The teacher group had a similar lecture given by school teachers, including supporting materials which were available throughout the academic year. Oral health knowledge and behavior were evaluated with a questionnaire at baseline, and then at 1 and 6 months. In total, 110 students were randomly selected to undergo a plaque accumulation assessment according to the Silness-Löe Index at baseline and 1 month later to determine the effects of the education programs on oral hygiene. At baseline, tooth-brushing frequency was similar in the study groups. Compared with baseline, the frequency of brushing increased significantly after 1 and 6 months in both groups ( p < .001). Teacher education was more effective for teaching correct brushing techniques ( p < .001). A significant decrease in plaque accumulation has been evaluated in both study groups at the 1-month examination after the education session ( p < .05). Both OHE programs were found to generate improvements in knowledge and behavior of children on oral health and plaque control in the short term.

A cluster randomized theory-guided oral hygiene trial in adolescents-A latent growth model.

OBJECTIVES: (i) To test whether theory-guided interventions are more effective than conventional dental instruction (CDI) for changing oral hygiene in adolescents and (ii) to examine whether such interventions equally benefit both genders and different socio-economic (SES) groups. METHODS: A total of 244 adolescents were recruited from three schools, and cluster randomization allocated adolescents to one of the three types of interventions: two were theory-based interventions (Precaution Adoption Process Model or Authoritative Parenting Model) and CDI served as an active control. Oral hygiene levels % (OH) were assessed at baseline, after 3 months and after 12 months. RESULTS: A complete data set was available for 166 adolescents (the total follow-up rate: 69%). There were no significant differences in baseline OH between those who participated throughout the study and those who dropped out. Bivariate and multivariate analyses showed that theory-guided interventions produced significant improvements in oral hygiene and that there were no significant gender or socio-economic differences. CONCLUSIONS: Theory-guided interventions produced more positive changes in OH than CDI, and these changes did not differ between gender and SES groups.

PeP-SCOT a health coaching intervention for people in prisons: the development of the intervention protocol.

There is a need for an alternative approach for health promotion prisons since previous work has indicated that health education, while improving health knowledge, does not result in behaviour change. Evidence has suggested that a health coaching assists in this regard. However, the question remained whether this approach would be appropriate and possible in prisons? This paper presents the public health strategies used to work in partnership with prison management to address challenges and accept opportunities as a health coaching intervention protocol was developed for oral health and wellbeing in the prison setting.

Curriculum influence on interdisciplinary oral health education and practice.

OBJECTIVES: Oral diseases are very prevalent across the lifespan and impact overall health, yet are largely preventable. The Smiles for Life (SFL) curriculum was created to educate healthcare providers about oral disease and support integration of oral health and primary care. This study examines SFL's influence on clinical practice and education. METHODS: Surveys were sent to registered users of SFL. Users who self-identified as direct care providers (DCPs), or educators, were included in the analysis. RESULTS: Survey response rate was 18 percent, with 87 percent identifying as DCPs and 13 percent as educators. Across professions, 85 percent of DCPs reported SFL influencing their practice to some degree, with variance among profession type and experience. DCPs most commonly reported that SFL led them to improve how they conduct oral health activities, with 60 percent performing the activity more skillfully following completion of SFL. Fluoride varnish application was the most common practice behavior initiated, and caries risk assessments was the oral health activity affected to the greatest degree. A majority of educators (94 percent) reported that SFL led them to incorporate or enhance oral health in their teaching. SFL helped educators emphasize the importance of oral health, improved their ability to teach content, raised motivation, and reduced barriers to teaching oral health. CONCLUSIONS: Data supports that SFL is positively influencing oral health practice across professions, especially in areas of caries risk assessment and fluoride varnish application. SFL improves the frequency and quality with which DCPs and educators participate in oral health activities, and facilitates oral health inclusion in primary care.

Self-efficacy theory-based intervention in adolescents: a cluster randomized trial-focus on oral self-care practice and oral self-care skills.

AIM: The cluster randomized trial tested the efficacy of professional dental education for improving oral self-care skills (OSC-S) and oral self-care practice (OSC-P) in adolescents. DESIGN: All 15- to 16-year-old adolescents from four public schools were invited and 206 agreed to participate. Schools were randomly allocated to the intervention group and to the control group. Five sessions were given for the intervention group and one for the control group. The OSC-S and OSC-P outcomes were measured as % Oral Cleanliness Scores at the baseline, 6-month, and 12-month observations. RESULTS: OSC-S and OSC-P correlated significantly (Pearson's) at the baseline (r = 0.777, P < 0.001), at the 6-month (r = 0.745, P < 0.001), and at the 12-month (r = 0.780, P < 0.001) examinations. After the guided oral healthcare interventions, a significant time × group effect was observed (repeated-measures anova, P < 0.001 for the OSC-S (multivariate η2 = 0.355) and for the OSC-P (multivariate η2 = 0.325). CONCLUSION: (i) Oral self-care skills and oral self-care practice scores were significantly correlated, (ii) self-efficacy theory-guided intervention was superior to the conventional dental instruction to improve oral self-care in adolescents, and (iii) varying levels of oral self-care improvement were observed among the intervention group adolescents.

Improving oral health for older people in the home care setting: An exploratory implementation study.

AIM: To explore how home care providers can support older people to maintain good oral health through implementing a model called Better Oral Health in Home Care (BOHHC). METHODS: A mixed method, pre- to post-implementation design was used. The Promoting Action on Research Implementation in Health Services framework informed the model's implementation process. RESULTS: High levels of dental need were identified at pre-implementation. Older people self-reported significant oral health improvements following the introduction of tailored home care strategies by care workers, who in turn reported a better understanding and knowledge of the importance of oral care for older people. CONCLUSION: The BOHHC Model provided an evidence-based approach for community-based prevention and early detection of oral health problems. Improving oral health for older people in the home care setting has significant practice and policy implications which require ongoing intersectoral facilitation involving aged care, vocational health education and dental sectors.

[Motivation for Prevention in Childhood as a Basis for long-Term Dental Health: The Augsburg Model]. / Motivation zur Prävention im Kindesalter als Basis für eine nachhaltige Zahngesundheit - Das Augsburger Modell.

Oral health promotion programs have been shown to be more effective the earlier they are started. In the city of Augsburg, the activities of the School Dental Service were replaced by a cooperation model in 2001, which provides a reasonable combination of group and individual dental prophylaxis. Three epidemiological evaluations show continuously increasing rates of natural healthy primary teeth in preschool children of all population groups. The Augsburg cooperation model "child and youth dental health" represents a practice-oriented approach in accordance with the new German prevention law.

A theory-guided school-based intervention in order to improve adolescents' oral self-care: a cluster randomized trial.

AIM: To evaluate the efficiency of social-cognitive theory-guided oral hygiene interventions in adolescents and to identify predictors of adolescents' self-care practice. DESIGN: A cluster randomized trial included 197 15- to 16-year-olds from two secondary schools. The intervention group received three face-to-face educational hands-on sessions facilitated by a dentist and adolescents worked in pairs. Individual dental plaque levels were measured at baseline, after intervention, at six and at 12 months. The structured questionnaire inquired about gender, family socio-economic status (baseline), and different social-cognitive domain variables (baseline, six, and 12 months). RESULTS: At baseline, there were no statistically significant differences in dental plaque scores between the intervention and control groups (P = 0.183). At the 6-month follow-up, the intervention group had significantly less dental plaque than the control group (P = 0.047), but the intergroup difference in dental plaque levels was not significant at the 12-month follow-up (P = 0.400). Variations in dental plaque levels at different time periods were explained by the following predictors: family's socio-economic status, social-cognitive domain variables, group affiliation, and baseline plaque levels. CONCLUSIONS: Social-cognitive theory-guided interventions improved oral self-care of adolescents in the short term. After the intervention was discontinued, the improvement in oral self-care of adolescents lasted for another 5 months.

Improving oral hygiene for patients.

Systematic reviews and patient safety initiatives recommend that oral hygiene should be part of routine patient care. However, evidence suggests it is often neglected in hospitals and care homes. Research recommends encouraging beliefs that support oral hygiene, and teaching nurses appropriate skills, as necessary prerequisites to implementing best practice in hospital wards. This article describes a pilot study of an educational workshop on oral hygiene. Results from the pilot study suggest that this workshop is a feasible intervention for a service-wide trial. The literature suggests that other interventions are required to complement this approach if nurses are to make oral hygiene a priority in daily patient care.

Percepção e conhecimentos de estratégias de gestão para o ingresso no mercado de trabalho dos alunos que cursaram o último ano da Faculdade de Odontologia da Universidade de São Paulo em 2014 / Perception and knowledge of management strategies for entering the labor market for the students who attended the last year of the Faculty of Dentistry of University of São Paulo in 2014

As Diretrizes Curriculares Nacionais para o curso de graduação em Odontologia determinam que, dentro das competências e habilidades que o cirurgião-dentista precisa desenvolver, encontra-se a capacidade de administração e gerenciamento de sua carreira, devendo estar apto para ser empreendedor, gestor e empregador, bem como para exercer papel de liderança dentro das equipes de saúde bucal. Nesse contexto, o objetivo do presente estudo é verificar a percepção e os conhecimentos dos alunos do último ano da Faculdade de Odontologia da Universidade de São Paulo em relação às estratégias de gestão para o ingresso no mercado de trabalho. Para tanto, foi realizado um estudo transversal, aplicando-se um questionário aos alunos que já haviam cursado a disciplina de Gestão e Planejamento em Odontologia de 2014. Os resultados foram tabulados em planilha Excel e analisados no pacote estatístico STATA 13.0. Dos 109 alunos matriculados na disciplina, 107 (99%) participaram da pesquisa, sendo a amostra composta por média de idade de 25 anos e por 70% dos participantes do gênero feminino. A partir da análise dos resultados, foi possível observar que 35,51% dos alunos sabem descrever com clareza o objetivo da organização na qual pretendem trabalhar; 45,79% acreditam que estão diante de uma oportunidade real para obter sucesso profissional; 58,88% estão seguindo esse caminho pela satisfação profissional; 37,38% aceitam riscos; 34,64% acreditam ter conhecimentos para gerir um bom negócio; e 54,21% consideram ter capacidade para liderar pessoas

Foi possível concluir, com este estudo, que a disciplina em questão consegue desempenhar o seu papel de auxiliar e orientar os alunos nessa transição para o ingresso no mercado de trabalho, tendo sido efetiva no aprendizado dos conhecimentos referentes às estratégias de gestão e empreendedorismo para esse início de carreira. Nesse sentido, observa-se ser fundamental que, ao longo do curso de graduação, a matriz curricular englobe conteúdos de gestão para o melhor desenvolvimento dessa competência

The National Curriculum Guidelines for the degree course in Dentistry determine that, within the skills and abilities that the surgeon dentist needs to develop, it is the ability of administration and management of his career, and he should be able to be an entrepreneur, manager and employer and to exercise leadership role within the oral health teams. In this context, the aim of this study is to verify the perception and knowledge of students in the last year of the Faculty of Dentistry of University of São Paulo in relation to management strategies for entering the labor market. Thus, a cross-sectional study was conducted by applying a questionnaire to students who already had studied Management and Dentistry Planning in 2014. The results were tabulated in an Excel spreadsheet and analyzed using the statistical package STATA 13.0. Among the 109 students enrolled in the course, 107 (99%) participated in the survey, the average age of the sample was 25 years old and 70% were female. From the analysis of the results, it was observed that 35.51% of students know clearly describe the organization's purpose in which they wish to work; 45.79% believe they are facing a real opportunity for professional success; 58.88% are following this path by job satisfaction; 37.38% take risks; 34.64% believe they have knowledge to manage a good deal; and 54.21% consider having the ability to lead people. It was possible to conclude from this study that the discipline in question manages its role to assist and guide students in the transition for entering the job market. It was effective in teaching entrepreneurship and management strategies for this early career. In this sense, it is observed it is essential that, throughout the course, the curricular matrix covers management contents for the best development of this competence

Oral health promotion among rural school children through teachers: an interventional study.

BACKGROUND: The lack of national oral health policy and organized school dental health programs in the country call for affordable, accessible, and sustainable strategies. OBJECTIVES: The objective was to compare the oral hygiene, plaque, gingival, and dental caries status among rural children receiving dental health education by qualified dentists and school teachers with and without supply of oral hygiene aids. MATERIALS AND METHODS: This interventional study was conducted among 15-year-old children selected randomly from four schools in Nalgonda district between September 2009 and February 2010. Schools were divided into four different intervention groups. The intervention groups varied in the form of intervention provider and frequency of intervention one of which being the control group. The oral hygiene, plaque, gingival, and dental caries status was assessed at baseline and 6 months following the intervention. SPSS 16 was used for analysis. RESULTS: The preintervention and postintervention comparison within each group revealed a substantial reduction in mean oral hygiene index-simplified (OHI-S), plaque index (PI), and gingival index (GI) at postintervention compared to baseline in group 4 (1.26, 0.87, and 0.74, respectively) followed by group 3 (0.14, 0.37, and 0.12, respectively). The OHI-S, PI, and GI scores increased in group 1 (0.66, 0.37, and 0.34, respectively) and group 2 (0.25, 0.19, and 0.14, respectively). Mean decayed, missing filled surfaces score between the groups was not statistically significant at baseline and postintervention. CONCLUSION: The dramatic reductions in the OHI-S, PI, and GI scores in the group supplied with oral hygiene aids call for supplying low cost fluoridated toothpastes along with toothbrushes through the school systems in rural areas.

School-based oral health-education program using experiential learning or traditional lecturing in adolescents: a clinical trial.

The aim of this project was to compare the effectiveness of experiential learning (EL) and traditional lecturing (TL) school-based oral health education on the oral health knowledge, attitude, habits, oral hygiene, gingival health and caries incidence of 13-year-old Greek children. Eighty-seven children for the EL group and 80 for the TL group were selected from two areas of Greece. Information on oral health knowledge, attitude and behaviours were obtained using a questionnaire. Dental plaque was recorded using a modified hygiene index, gingivitis was assessed using the simplified gingival index and dental caries was measured by recording the number of Decayed, Missing and Filled teeth (DMFT) using the British Association for the Study of Community Dentistry (BASCD) criteria. All children were examined by two calibrated dentists, using a World Health Organisation (WHO) periodontal probe and artificial light. Questionnaires were delivered and clinical examinations were performed at baseline and at 6 and 18 months post-intervention. The EL oral health educational programme was implemented by teachers using the programme's manual. Oral health knowledge had improved significantly (P < 0.001) in both groups at 6 and 18 months post-intervention. Oral health behaviour (P < 0.001) and attitude (P < 0.05) had improved significantly at 6 months, and oral hygiene and gingival health had improved significantly at both 6 (P < 0.001) and 18 (P < 0.05) months for the EL group. Lower caries incidence was recorded for the EL group, 18 months post-intervention (P < 0.05). School-based oral health EL for adolescents was found to be more effective than TL in improving oral health attitude and behaviour at 6 months, in improving oral hygiene and gingival health at both 6 and 18 months and in reducing caries incidence 18 months post-intervention.

Preventive services program: a model engaging volunteers to expand community-based oral health services for children.

PURPOSE: This paper describes the Preventive Services Program (PSP), a community based oral health program model which engages volunteers to provide preventive services and education for underserved children in Missouri. In 2006, the Missouri Department of Health and Senior Services created a program for children designed to use a systems approach for population-based prevention of oral disease. Currently, 5 part-time dental hygienists serve as Oral Health Program Consultants to work with the citizens of a community to engage dentists, dental hygienists, parents and other interested stakeholders in the activities of the program. Dental volunteers evaluate oral health and disease in the community's children and facilitate referrals for dental care. Other volunteers apply fluoride varnish and provide educational services to the children. PROGRAM OUTCOMES: In 2006, 273 volunteer dentists and dental hygienists and 415 community volunteers provided oral screenings, oral health education, 2 fluoride varnish applications and referral for unmet dental care for 8,529 children. In 2011, 775 volunteer dentists and dental hygienists and 1,837 other community volunteers provided by PSP services to nearly 65,000 children. CONCLUSION: It has been demonstrated that when the local citizens take responsibility for their own needs that a sustainable and evidence-based program like PSP is possible. Guidelines which provide criteria for matching models with the specific community characteristics need to be generated. Furthermore, a national review of successful program models would be helpful to those endeavoring to implement community oral health program.

Primary oral health care.

The aim of this review was to describe the background and evolution of primary oral health care (POHC), including the development of an oral health policy, by identifying the resources necessary for oral health services, reviewing the evidence of the effectiveness of oral health promotion and education, providing essential oral health care, and establishing evidence of the benefits of regular dental visits for effective POHC. At present, evidence for the effectiveness of oral health education and regular dental visits is very weak. Nevertheless, POHC needs to be developed as an integral part of primary health care (PHC). Therefore, a need exists to increase financial investment, resources and workforce in PHC to lower the prevalence of dental caries and periodontal disease in the Middle-East using the POHC approach.

Strengthening of oral health systems: oral health through primary health care.

Around the globe many people are suffering from oral pain and other problems of the mouth or teeth. This public health problem is growing rapidly in developing countries where oral health services are limited. Significant proportions of people are underserved; insufficient oral health care is either due to low availability and accessibility of oral health care or because oral health care is costly. In all countries, the poor and disadvantaged population groups are heavily affected by a high burden of oral disease compared to well-off people. Promotion of oral health and prevention of oral diseases must be provided through financially fair primary health care and public health intervention. Integrated approaches are the most cost-effective and realistic way to close the gap in oral health between rich and poor. The World Health Organization (WHO) Oral Health Programme will work with the newly established WHO Collaborating Centre, Kuwait University, to strengthen the development of appropriate models for primary oral health care.

The research agenda on oral health inequalities: the IADR-GOHIRA initiative.

The World Health Organization asserts that oral health is a basic human right, yet this is a right enjoyed by few. Oral disease is a major problem in high-income countries, where the cost of treating oral diseases often exceeds that for major non-communicable diseases. In low-to-middle income countries, oral diseases are a severe and growing public health problem. Furthermore, major inequalities exist both within and between countries in terms of disease severity and prevalence, and major social gradients exist in the prevalence of oral disease. The International Association for Dental Research (IADR) has responded to the challenge of poor oral health and oral health inequalities through the Global Oral Health Inequalities: the Research Agenda (GOHIRA) initiative. In a Call to Action it has set out the priorities for research that can lead to a reduction in oral health inequalities. Three key challenges have been identified, namely gaps in knowledge and an insufficient focus on social policy, the separation of oral health from general health, and inadequate evidence-based data. Ten key research priorities have been identified with due regard to the differing needs of the variety of global health care systems, and a set of prioritized outcomes and a timeline for implementation have been defined. In the wider context of the proposals set out above, five immediate priorities for action have been proposed.