The relationship between overprotective parenting, toothbrushing practices and children's behaviour during dental treatments in 4 to 11-year-old Dutch children: a cross sectional study.

PURPOSE: Overprotective parenting and its impact on child development has gained increasing public attention. This study explored the association between overprotective parenting and behaviour during dental treatments and toothbrushing behaviour of 4 to 11-year-old-children. METHODS: In this cross-sectional study, caregivers of 4-to-11-year-old children who visited a referral practice for dental treatment in Leiden, The Netherlands, completed a questionnaire about overprotective parenting, using the Parental Overprotection Measure (POM), and children's toothbrushing behaviour. The dentist and dental assistant used the Venham scale to assess children's behaviour during dental treatments. Associations between the POM and the Venham scale and toothbrushing variables, were analysed using multiple ordered logistic regression. RESULTS: The sample included 96 children (mean age: 7.3 ± 2.1 years, 59 boys). Overprotective parenting (higher POM scores) was significantly associated with more disruptive behaviour of children during dental treatments (higher Venham categories) (OR: 1.08 (95% CI 1.04; 1.13)) and lower caregiver self-efficacy regarding toothbrushing (OR 0.96 (95% CI 0.93; 0.99)), after adjustment for confounders. No associations between overprotective parenting and toothbrushing frequency or skipping toothbrushing were found. CONCLUSIONS: Overprotective parenting has been associated with children's negative behaviour during dental treatments and lower caregiver self-efficacy regarding toothbrushing in primary school children who are treated in a referral practice for paediatric dental care.

Dental healthcare costs of children living in Amsterdam and associated socio-demographic characteristics.

OBJECTIVES: The aim of this study was to assess associations between socio-demographic characteristics and dental costs of children living in Amsterdam. Having incurred dental costs was an indicator for having visited the dentist. Having incurred low or high dental costs may indicate the type of dental care provided (periodic examination, preventive care or restorative treatment). METHODS: This study followed a cross-sectional, observational design. The research population contained all children up until 17 years living in Amsterdam in 2016. Dental costs from all Dutch healthcare insurance companies were obtained via Vektis, and socio-demographic data were obtained from Statistics Netherlands (CBS). The study population was stratified into age groups: 0-4 and 5-17 years. Dental costs were classified as no dental costs (0 euros), low dental costs (>0 to <100 euros) or high dental costs (≥100 euros). Univariable and multivariable logistic regression analyses were performed to study the distribution of dental costs and associations with socio-demographic child and parent variables. RESULTS: In the population of 142 289 children, 44 887 (31.5%) incurred no dental costs, 32 463 (22.8%) incurred low dental costs and 64 939 (45.6%) incurred high dental costs. Among children of 0-4 years, a much larger proportion (70.2%) incurred no dental costs, compared to those of 5-17 years (15.8%). In both age groups, migration background (adjusted Odds Ratio (aOR) range 1.23-1.98), low(er) household income (aOR range 0.45-0.93), low(er) parental educational level (aOR range 0.51-0.87) and living in a single-parent household (aOR range 0.89-0.91) were strongly associated with incurring high (vs. low) dental costs. Furthermore, in 5-17-year-old children, a lower level of secondary or vocational education (aOR range 1.12-1.17) and living in households receiving social benefits (aOR 1.23) were associated with incurring high dental costs. CONCLUSIONS: Among children living in Amsterdam in 2016, one in three children did not visit a dentist. For children that did visit a dentist, those with a migration background, low parental educational level and from a low household income were more likely to incur high dental costs, which could be indicative for additional restorative treatment. Hence, patterns of oral healthcare consumption, specified by type of dental care over time, and their association with oral health status, are targets for future research.

[International volunteer projects in oral care: an inventory of successful characteristics]. / Internationale vrijwilligersprojecten in de mondzorg: een inventarisatie van succesvolle kenmerken.

This study provides an overview of Dutch oral healthcare volunteer projects abroad and describes to what extent these projects meet the characteristics of a successful volunteer project. These characteristics are based on literature studies and include: preparation of the project, project goal, suitability for the specific population, general approach and scientific justification, composition of the team, sustainability of the project, ethics, external collaborations and sponsors, evaluation of the project, and safety of the volunteers. This study identified 24 Dutch volunteer projects abroad, based on a systematic search. Most of them meet the characteristics of 'project goal and suitability,' 'team composition,' and 'external collaboration and sponsoring.' The information provided for the other characteristics was incomplete, which means that no statements can be made as to the fulfillment of these requirements. These results provide insights into how existing and new volunteer projects can be (further) developed to contribute to oral healthcare in low- and middle-income countries in an effective and well-suited manner.

[Stars: a practical and positive intervention to improve tooth-brushing behaviour]. / 'Uitblinkers': een praktische en positieve interventie voor het verbeteren van poetsgedrag.

At the basis of oral care for young people is improving self care. This is not always easily done in practice. The Dutch Oral Health Research Agenda of 2018 revealed that oral care professionals need an effective method to change the behaviour of their patients. 'Uitblinkers' (Stars) is a theory-based interview method for oral care professionals to help parents improve their 2- to 10-year-old children's tooth brushing. The interview method aims at learning pedagogical skills so tooth brushing in children happens more easily. This article provides a description of the 'Uitblinkers' intervention, highlighting 3 key components: how to make parents receptive to advice from the oral care professional, how to identify barriers that parents experience when brushing their children's teeth, and how to achieve an appropriate approach to tackling the identified barriers to tooth brushing.

[Feasibility of the 'Uitblinkers' intervention to improve toothbrushing among children: a pilot study]. / Toepasbaarheid van de 'Uitblinkers-interventie' om tandenpoetsen bij kinderen te verbeteren: een pilotonderzoek.

In 2017, the 'Uitblinkers' intervention was developed to improve toothbrushing behaviour among young children. This interview method focuses on identifying parents' barriers to brushing their children's teeth, and promoting parenting strategies to tackle the identified barriers. Twenty-one trained dental therapists from twelve dental practices applied the 'Uitblinkers' intervention among parents of three-year-old children. Nine months after the training, focus group- and telephone interviews were conducted to evaluate the feasibility and appreciation of the intervention in dental practice. Findings of this study show that the 'Uitblinkers' intervention offers a feasible approach to improve children's toothbrushing behaviour. Dental therapists were generally positive about the interview method, the supporting materials and the reactions of parents. Some (logistic) barriers to adoption were identified which, if resolved, would improve the implementation of the intervention in dental practice.

Usage and Scientific Properties of the ADVOCATE Oral Health Care Measures.

BACKGROUND: Feedback information about the quality of oral health care is important for reflective learning by oral health care professionals and the wider health system. To this end, a list of 48 topics describing oral health and oral health care was recently agreed as part of the EU H2020 ADVOCATE project. OBJECTIVE: This article reports on the formulation of measures based on the ADVOCATE topics and provides information on usage, reporting, validity, and reliability of the measures. METHODS: The AIRE instrument was used to guide the methodological approach adopted. The appropriateness of the measures was tested among 39 general dental practitioners (GDPs) in Denmark, Germany, and the Netherlands. Data were collected from a convenience sample of patients via a questionnaire deployed in an online application in their practice. Feasibility, acceptability, and usefulness of the measures were evaluated through focus group interviews with GDPs. Face validity and test-retest reliability of the measures were assessed. RESULTS: For 46 of the 48 topics, a measure could be defined by constructing a definition and a numerator and denominator. Data collection for all 46 measures was feasible and acceptable for patients using the online questionnaire. The practicalities of using claims data for the purpose of giving feedback to individual and groups of GDPs proved to be challenging in terms of timely access of such data, the granularity of the data, and matching the content of the data with the consented items on quality of oral health care. Face validity was considered appropriate, as the patients found the questionnaire easy to understand. Test-retest reliability was found to be acceptable for 36 of 46 measures. CONCLUSION: The broad range of the ADVOCATE oral health care measures could make a useful contribution to a more transparent, evidence-based, and patient-centered oral health care system. KNOWLEDGE TRANSFER STATEMENT: This study shows the usage, reliability, and validity of 46 oral health care measures. The measures, which include patient experience and health behaviors, were found to be useful to stimulate discussions about clinical practice. The measures can provide essential information for quality improvement strategies and useful and relevant feedback information for GDPs.

Improving oral healthcare using academic detailing - design of the ADVOCATE Field Studies.

Background: Academic detailing (AD) is a defined form of educational outreach that can be deployed to intrinsically motivate practitioners towards improving quality of care. This paper describes the design of the ADVOCATE Field Studies. This proof of concept study aims to evaluate the feasibility, acceptability and usefulness of AD, reinforced with feedback information to promote prevention-oriented, patient-centred and evidence-based oral healthcare delivery by general dental practitioners (GDPs). Methods: Six groups of GDPs will be recruited; two groups of six to eight GDPs in each of three countries - the Netherlands, Germany and Denmark. GDPs will meet for four Academic Detailing Group (ADG) meetings for open discussions using comparative feedback data to stimulate debate about their dental practice performance and care delivery. Group meetings will be moderated using the AD methodology. Qualitative data will be collected through focus group interviews, an online discussion forum, field notes and debriefs of ADG meetings and analysed by conventional content analysis using MaxQDA software. Discussion: The results of the study will provide novel information on the feasibility, perceived acceptability and usefulness of AD and feedback data for GDPs to improve oral healthcare delivery.

[The family's influence on the oral health of children. A peek behind the front door]. / De invloed van het gezin op de mondgezondheid van kinderen. Een kijkje achter de voordeur.

The prevention of dental caries seems fairly easy. The disease can largely be avoided by the daily removal of dental plaque using fluoride toothpaste and the control of sugary intakes. Most parents have sufficient knowledge and motivation to adhere to this prevention advice with respect to their children. Actual practice, however, proves quite difficult because parents experience barriers in implementing the advice. This article provides an overview of the most important family-related factors that influence children's oral health behaviour and dental caries experience. Factors include oral health-related attitudes of the parents, the way that parents deal with their children and communicate with them (parenting practices) and the organisation of daily life within the family (family functioning). It's important for oral health care providers to engage in conversations with parents to identify possible barriers. Tailored advice can then be given to help them improve their oral health behaviour.

A Consensus-Based Set of Measures for Oral Health Care.

Increasingly more responsive and accountable health care systems are demanded, which is characterized by transparency and explicit demonstration of competence by health care providers and the systems in which they work. This study aimed to establish measures of oral health for transparent and explicit reporting of routine data to facilitate more patient-centered and prevention-oriented oral health care. To accomplish this, an intermediate objective was to develop a comprehensive list of topics that a range of stakeholders would perceive as valid, important, and relevant for describing oral health and oral health care. A 4-stage approach was used to develop the list of topics: 1) scoping of literature and its appraisal, 2) a meeting of experts, 3) a 2-stage Delphi process (online), and 4) a World Café discussion. The aim was to create consensus through structured conversations via a range of stakeholders (general dental practitioners, patients, insurers, and policy makers) from the Netherlands, Germany, the United Kingdom, Ireland, Hungary, and Denmark. The study was part of the ADVOCATE project, and it resulted in a list of 48 topics grouped into 6 clusters: 1) access to dental care, 2) symptoms and diagnosis, 3) health behaviors, 4) oral treatments, 5) oral prevention, and 6) patient perception. All topics can be measured, as they all have a data source with defined numerators and denominators. This study is the first to establish a comprehensive and multiple-stakeholder consented topic list designed for guiding the implementation of transparent and explicit measurement of routine data of oral health and oral health care. Successful measurement within oral health care systems is essential to facilitate learning from variation in practice and outcomes within and among systems, and it potentiates improvement toward more patient-centered and prevention-oriented oral health care.

Toward More Patient-Centered and Prevention-Oriented Oral Health Care: The ADVOCATE Project.

ADVOCATE (Added Value for Oral Care) is a project funded by the European Commission's Horizon 2020 program, which aims to develop strategies for a system transition toward more patient-centered and prevention-oriented oral health care delivery within health care systems. This system should balance the restorative and preventive approaches in dental and oral health care. ADVOCATE is a partnership among 6 European Union member states, which involves collaboration among universities, state-funded health care providers, and private insurance companies in Denmark, Germany, Hungary, Ireland, the Netherlands, the United Kingdom, and Aridhia, a biomedical informatics company based in Scotland. There are 6 interrelated work packages, which aim to address the following objectives: 1) in-depth evaluation of oral health care systems in European Union member states to identify best system designs for oral disease prevention, 2) development of a set of measures to provide information on oral care delivery and oral health outcomes, 3) evaluation of a feedback approach in dental practice that aims to facilitate a change toward preventive oral health care delivery, and 4) economic evaluation of strategies to promote preventive oral health care and development of policy recommendations for oral health care systems. The project is novel in its use of data that are routinely collected by health insurance organizations, as well as the engagement of key stakeholders from dental teams, insurers, patients, and policy makers in guiding the development and progress of the project. This article outlines in detail the objectives and research methodology of the ADVOCATE project and its anticipated impact. Knowledge Transfer Statement: This commentary describes the development of policy options to promote a greater focus on disease prevention in general dental practice. The approach builds on identifying the comparative effectiveness of alternative incentive schemes, as well as methods to monitor clinical and patient-derived measures of success in creating health for patients. The article describes the development and application of the measures and the evaluation of their success in orienting clinical practice more toward disease prevention.

Improving oral healthcare: towards measurement?

In the last 30 years oral healthcare is increasingly being contested. Needs and expectations have evolved to a point of advanced restorative techniques, long term planning for preventative care and evidence-based practice, and patients and payers increasingly require more explicit demonstration of competence. However, relevant data are currently not routinely collected that would support approaches needed to further improve oral health and care. This paper sets out the case to collect and evaluate routinely available data. Variations in care and oral health could be described, which in turn would provide valuable insights for all wishing to further improve oral health and care.

The relationship between parenting, family interaction and childhood dental caries: a case-control study.

The aim of this case-control study was to explore the relationship between parenting practices, parent-child interaction and childhood dental caries, using a sample of 5-8-year old children from the Netherlands. Cases were defined as children with four or more decayed, missing or filled teeth and controls were caries free. Cases (n = 28) and controls (n = 26) were recruited from a referral centre for paediatric dental care and a general dental practice, respectively. Parenting practices and parent-child interactions of the child's primary caregiver were observed using Structured Interaction Tasks and subsequently rated on seven dimensions: positive involvement, encouragement, problem-solving, discipline, monitoring, coercion and interpersonal atmosphere. All Structured Interaction Tasks were videotaped, and coded by trained and calibrated observers blind to the dental condition. Differences in parenting dimensions between cases and controls were analysed using multivariate analysis of variance, independent samples T-tests, χ(2)-tests and multiple logistic regression analyses. Controls had significantly higher scores on the dimensions positive involvement, encouragement, problem-solving and interpersonal atmosphere, compared to cases. Parents of controls were also less likely to show coercive behaviours. These associations remained statistically significant after adjustment for the mother's education level, tooth brushing frequency and the frequency of consuming sugary foods and drinks, except for coercion. There was no significant difference in discipline between cases and controls. In conclusion, this case-control study found a significant relationship between parenting practices, parent-child interaction quality and childhood dental caries. Our findings suggest that parenting practices may be an important factor to consider in caries preventive programs.

Family relationships as an explanatory variable in childhood dental caries: a systematic review of measures.

It is widely acknowledged that parental beliefs (self-efficacy) about oral health and parental oral health-related behaviours play a fundamental role in the establishment of preventative behaviours that will mitigate against the development of childhood dental caries. However, little attention has been given to the wider perspective of family functioning and family relationships on child oral health. For oral health researchers, exploration of this association requires the use of reliable, valid and appropriate assessment tools to measure family relationships. In order to promote methodologically sound research in oral health, this systematic review aims to provide a guide on self-report psychometric measures of family functioning that may be suitable to utilize when exploring childhood dental caries. This systematic review has identified 29 self-report measures of family functioning and evaluated them in terms of their psychometric support, constructs measured and potential utility for oral health research. The majority of the measures reported adequate levels of reliability and construct validity. Construct evaluation of the measures identified five core domains of family functioning, namely 'communication', 'cohesion/engagement', 'control', 'involvement' and 'authoritative/rigid parenting style'. The constructs were subsequently evaluated with respect to their potential relevance to child oral health. Herewith this review provides a framework to guide future research to explore family functioning in furthering our understanding of the development of childhood dental caries.

Oral health of female prisoners in HMP Holloway: implications for oral health promotion in UK prisons.

OBJECTIVES: This study describes the oral health status and associated risk factors in a sample of female prisoners and compares their oral health to that of the female population from the 2009 Adult Dental Health Survey. METHOD: A random sample of prisoners was selected from HMP Holloway, London. Structured interviews were carried out to collect information on oral health behaviours and oral health related quality of life. Clinical examinations using the Adult Dental Health Survey criteria assessed the oral health needs of prisoners. RESULTS: The mean age of female prisoners (n = 103) was 30.9 ± 9.6 years. The prevalence of oral diseases was high. Seventy-five percent had decayed or unsound teeth. The mean DMFT was 12.3 ± 7.5. Compared to the general female population, prisoners had more decayed and fewer filled teeth. Sixty-six percent had periodontal pockets of 4 mm or more. A large proportion (73%) reported at least one oral impact on daily performances. Prisoners were more likely than the general female population to engage in oral health damaging behaviours such as high sugar intake and smoking. CONCLUSION: This survey has demonstrated the poor state of oral health and identified considerable levels of unmet dental treatment needs in HMP Holloway. Urgent action is required to address this major public health problem.