Association between dental clinical measures and oral health-related quality of life among Iraqi schoolchildren: A cross-sectional study.

OBJECTIVE: The aim of this study was to assess the association between dental clinical measures and oral health-related quality of life (OHRQoL) together with the potential mediating role of sociodemographic factors and oral health behaviours on this association in a group of Iraqi children. METHODS: The target population for this cross-sectional study consisted of 372 primary school children aged 8-10 years in the city of Kut, Iraq, during the year 2022. The participants were selected using a multi-stage random sampling technique. Detailed information about the children was collected through a comprehensive questionnaire that included demographic characteristics, oral health-related behaviors, the Arabic version of the Child Perceptions Questionnaire for 8-10-year-olds (CPQ8-10), and parental knowledge regarding oral health. Additionally, clinical dental evaluations were conducted, which included assessments of decayed, missing, and filled surfaces (DMFS, dmfs) as well as teeth (DMFT, dmft). Simplified oral hygiene index (OHI-S), bleeding on probing (BOP), and the community periodontal index (CPI) were also recorded for each participant using the recommended methodology by the World Health Organization (WHO). The statistical analysis included the Chi-square test, independent t-test, and simple and multiple linear regressions. RESULTS: The mean age of the children was 9.0 (± 0.82) years. About one-third of children reported brushing at least two times per day and consuming a sweet snack once a day. Visiting a dentist during the past year was reported by 21% of children. Oral health behaviours demonstrated a significant association with the total CPQ8-10 scores (p < 0.001). Based on adjusted effects (ß and 95% CI) from the multiple linear regressions, untreated dental caries (dt > 0, DT > 0) had a negative impact on the total CPQ8-10 score (adjusted ß = 2.3 (95% CI: 0.67 to 3.91) and 3.4 (95% CI: 2.14 to 4.56), respectively). Decayed surfaces (DS), and teeth (DT) were associated with the total score of the CPQ8-10 and all its subscales (adjusted ß range = 0.1 (95% C.I.: 0.03 to 0.19)-1.0 (95% CI: 0.72 to 1.26) and 0.2 (95% CI: 0.004 to 0.40)-1.2 (95% CI: 0.91 to 1.67), respectively). There was an association between oral hygiene index and total CPQ8-10 scores (adjusted ß = 1.8 (95% CI: 0.62 to 3.02)), especially the functional limitations and emotional well-being subscales. CONCLUSION: Findings of this study emphasizes the negative impact of dental caries and poor oral hygiene on children's OHRQoL. This association is highlighted more when considering that over two-thirds of these children do not comply with favourable levels of oral health behaviour. Enhancing the level of OHRQoL among these children, therefore, necessitates comprehensive programs for decreasing the volume of unmet oral health needs and improving children's adherence to recommended oral health behaviours.

Understanding why oral health professionals migrate: A qualitative investigation of Iranian dentists who have moved to Canada (Oral health professionals' migration).

BACKGROUND: The migration of health professionals from Low- and Middle-Income Countries (LMICs) to High-Income countries (HICs) is an ongoing phenomenon that has been accelerating with globalisation. While there has been growing research around the migration of physicians and nurses, there is less understanding of the motives surrounding the migration of dentists, and even less about their migration from specific countries. OBJECTIVES: This qualitative study explores the migration motivations of Iranian dentists who have moved to Canada. METHODS: Semi-structured interviews of 18 Iranian-trained dentists in Canada were conducted to obtain information about their motives for migration. Interviews were coded and categorised into themes using qualitative thematic analysis. RESULTS: Motivations to migrate were grouped into four analytical areas: socio-political; economic; professional; and personal. An inverse relationship was identified between the strongest motives to migrate and the topics respondents were least comfortable discussing. Socio-political-related motives were predominant with respondents focusing on their dissatisfaction with the social ethos and restrictions on personal freedom within Iran. CONCLUSION: Country-specific context is critical to fully understand health professional migration; in particular, the dynamics and interplay between socio-political, economic, and professional/personal factors within the home country. While Iranian dentists' motives to migrate have some similarities to other health professionals who migrated from Iran, and dentists from other countries, differences need to be considered to fully understand migration patterns.

Oral health-related quality of life changes during phase 1 Class II malocclusion treatment using Frankel 2 and Twin-block appliances: A short-term follow-up study.

INTRODUCTION: Orthodontic treatment procedures affect oral health-related quality of life. This study analyzed and compared the patients using the Frankel 2 Regulator (FR2) and Twin-block (TB) orthodontic appliances. METHODS: This follow-up observational study comprised adolescents aged 10-16 years with Class II malocclusion seeking orthodontic treatment, between April and December 2019, in a private orthodontic clinic. Following the finalization of orthodontic clinical decisions, 88 patients, in a 1:1 ratio, using FR2 (n = 44) and TB (n = 44) appliances, were invited to participate in this study. An Oral Health Impact Profile-14 (OHIP-14) questionnaire was answered by the participants at 5-time points: before treatment, 1 week, 1 month, 3 months, and 6 months after wearing functional appliances. A mixed model for repeated measurements tested the OHIP-14 score mean differences over time among appliance groups and group by time interaction. RESULTS: The TB group consisted of 15 males and 29 females, and the FR2 group included 21 males and 23 females. The mean age of participants was 12.18 ± 1.29 years. The mean of OHIP-14 scores in FR2 users was significantly lower than the TB appliance group at all intervals (P <0.05). Although the total score of OHIP-14 increased 1 week after appliance wearing, it declined during the 1, 3, and 6 months after wearing appliances in both groups. CONCLUSIONS: The results can help orthodontists better select treatment approaches by considering their effect on oral health-related quality of life.

Friendship Network and Dental Brushing Behavior among Middle School Students: An Agent Based Modeling Approach.

By using a standard questionnaire, the level of dental brushing frequency was assessed among 201 adolescent female middle school students in Tehran. The initial assessment was repeated after 5 months, in order to observe the dynamics in dental health behavior level. Logistic Regression model was used to evaluate the correlation among individuals' dental health behavior in their social network. A significant correlation on dental brushing habits was detected among groups of friends. This correlation was further spread over the network within the 5 months period. Moreover, it was identified that the average brushing level was improved within the 5 months period. Given that there was a significant correlation between social network's nodes' in-degree value, and brushing level, it was suggested that the observed improvement was partially due to more popularity of individuals with better tooth brushing habit. Agent Based Modeling (ABM) was used to demonstrate the dynamics of dental brushing frequency within a sample of friendship network. Two models with static and dynamic assumptions for the network structure were proposed. The model with dynamic network structure successfully described the dynamics of dental health behavior. Based on this model, on average, every 43 weeks a student changes her brushing habit due to learning from her friends. Finally, three training scenarios were tested by these models in order to evaluate their effectiveness. When training more popular students, considerable improvement in total students' brushing frequency was demonstrated by simulation results.

Dental students' perceived barriers in geriatric dental care active involvement.

OBJECTIVES: The present study assessed dental students' perceived barriers to geriatric dental care provision. METHODS: Out of 512 dental students in Iranian dental schools were participated in the study 464 were completed the questionnaire. The mean age of the dental students was 25.5 ± 2.8 years; 67% were women. RESULTS: Most of the participants (79%) did not have any training focused on geriatric dental care, and the vast majority (more than 83%) had no experience with geriatric dental care. The primary barriers to provide dental care to the elderly that dental student mentioned included insufficient knowledge of geriatric dental care and perceived lack of communication skills and self-confidence in managing elderly patients. CONCLUSION: Increased emphasis on geriatric dental education in the undergraduate dental curriculums needed to minimize the barriers and improving dental students' willingness to serve older people.

Stewardship of National Oral Health system in Iran: its strengths and weaknesses.

AIMS: In this study, we assess the strengths, challenges and opportunities regarding the oral health system stewardship in Iran. METHODS: A mixed methodology was used, comprised of a quantitative questionnaire using the functional standards, semi structured interviews with key stakeholders and document review. The level of current attainments of each standard was determined based on a Likert-type scale. Literature review was completed to find official documents of national organizations. RESULTS: The responsibility of policy development of oral health care at the national level mostly falls on the Oral Health Bureau. This office has formulated a strategic plan for its policy-making and has considered the required capacity to implement them. However, the Bureau has some problems in enforcing its regulatory framework, especially in the private sector. There are rigorous problems in managing information and using them for evidence-based decision making. Setting and allocation of operational budgets for implementing the policies is only partially attained, as is monitoring and evaluating the performance. CONCLUSIONS: While the Ministry of Health and Medical Education has achieved some stewardship measures, it still needs further improvements in the oral health system. It needs to strengthen its information system and its executive capacity to implement the proposed regulations. The Ministry must improve accountability in the oral health system, especially the provider accountability.

Social insurance for dental care in Iran: a developing scheme for a developing country.

AIMS: This study aimed to describe the current situation with regard to dental care provided under social insurance in Iran in qualitative terms and to assess it critically with regard to equity and efficiency. METHODS: After a thorough review of the relevant literature, a template of topics, which included population coverage, range of treatment provided, contracting mechanisms, fees, level of co-payments and dental share of total health expenditures, was developed by a panel of Iranian health finance experts. It was used during interviews with informed persons from the different Iranian social funds. These interviews were recorded and transcribed. The transcriptions were checked for accuracy by those who had been interviewed and were then analysed. RESULTS: It was found that, currently, four major social funds are involved in health (including dental) insurance in Iran, under the supervision of The Supreme Council of Health Insurance, located at the newly integrated Ministry of Cooperatives, Labour & Social Welfare. Around 90% of Iranians are covered for health insurance within a Bismarckian system to which the employed, the employers, and the Government contribute. The system has developed piecemeal over the years and is characterised by a complexity of revenue-collection schemes, fragmented insurance pools, and passive purchasing of dental services. CONCLUSIONS: The dental sector of Iranian social insurance should establish a strategic purchasing plan for dental care with the aim of improving performance and access to care. Within the plan, there should be a basic benefit package of dental services based on the relative cost-effectiveness of interventions, educating an adequate number of allied dental professionals to provide simple services, and introducing mixed payment methods.

Tobacco cessation practices of senior dental students in Iran.

OBJECTIVE: Tobacco use is prevalent in Iran, especially among men. The aim was to assess cessation practices and identify perceived barriers to delivery of tobacco cessation services by Iranian senior dental students. DESIGN: Descriptive, cross-sectional study. SETTING: Iran, Schools of Dentistry, 2009-2010. PARTICIPANTS: 370 (response rate 82%) officially registered senior dental students selected through stratified random sampling. INTERVENTION: Students at 11 dental schools throughout the country completed the survey. MAIN OUTCOME MEASURE: Students' practice of the US Clinical Practice Guideline 5 As (ask, advise, assess, assist, arrange); interest in training; intention and barriers addressing tobacco use in dental settings. RESULTS AND CONCLUSIONS: Respondents were primarily female (67.8%). The students were far more likely to be actively involved in asking, advising and assessing patients to quit than in assisting and arranging. Most respondents (68.5%) agreed that it is within the scope of dental practice to help smokers quit. The most important barriers to providing cessation services included perceived patient resistance (44%) and lack of a supportive organisation (36%). This was the first assessment of approaches to tobacco users by dental students in Iran. Although there clearly is room for improvement, the interest of the students toward tobacco cessation is encouraging.