Evaluating the impact of a community developed collaborative project for the prevention of early childhood caries: the Healthy Smile Happy Child project.

INTRODUCTION: To determine the effectiveness of the Healthy Smile Happy Child (HSHC) project, a community-developed initiative promoting early childhood oral health in Manitoba, Canada. Specific aims were to assess improvements in caregiver knowledge, attitudes, and behaviours relating to early childhood oral health, and the burden of early childhood caries (ECC) and severe ECC (S-ECC). METHODS: A serial cross-sectional study design was selected to contrast findings following the Healthy Smile Happy Child (HSHC) campaign in four communities with the previous baseline data. One community was a remote First Nation in northern Manitoba and another was a rural First Nation in southern Manitoba. The other two communities were urban centres, one of which was located in northern Manitoba. A community-development approach was adopted for the project to foster community solutions to address ECC. Goals of the HSHC program were to promote the project in each community, use existing community-based programs and services to deliver the oral health promotion and ECC prevention activities, and recruit and train natural leaders to assist in program development and to deliver the ECC prevention program. The HSHC coordinator worked with communities to develop a comprehensive list of potential strategies to address ECC. Numerous activities occurred in each community to engage members and increase their knowledge of early childhood oral health and ultimately lead them to adopt preventive oral health practices for their young children. Children under 71 months of age and their primary caregivers participated in this follow-up study. A -value ≤0.05 was statistically significant. RESULTS: 319 children (mean age 38.2±18.6 months) and their primary caregivers participated. Significant improvements in caregiver knowledge and attitudes were observed following the HSHC campaign, including that baby teeth are important (98.8%), that decay involving primary teeth can impact on health (94.3%), and the importance of a dental visit by the first birthday (82.4%). Significantly more respondents indicated that their child had visited the dentist (50.2%) and had started brushing their child's teeth (86.7%) when compared to baseline. Overall, 52.0% had ECC, 38.6% had S-ECC. The mean deft score was 3.85±4.97 (range 0-20). There was no significant change is ECC prevalence between the follow-up and baseline investigations. However, age-adjusted logistic regression for S-ECC in this follow-up study revealed a significant reduction in prevalence compared with the baseline study (=0.021). Similarly, age-adjusted Poisson regression revealed that there were significant reductions in both the decayed teeth and decayed, extracted and filled teeth scores between follow-up and baseline study periods (0.016 and .0001, respectively). CONCLUSIONS: Follow-up study results suggest that the HSHC initiative may have contributed to improvements in caregiver knowledge, attitudes, and behaviours towards early childhood oral health and subsequently modest yet statistically significant reductions in caries scores and the prevalence of S-ECC.

Student perspectives of an online module for teaching physical assessment skills for dentistry, dental hygiene, and pharmacy students.

The integration of web-based learning into the curriculum of healthcare education has significantly increased over the past decade. This article aims to describe the student perspectives of an online module to teach physical assessment skills for pharmacy, dentistry, and dental hygiene students. A total of 103 students completed the online module: 48 third-year pharmacy students, 29 first-year dentistry students, and 26 first-year dental hygiene students. Students were asked to rate a list of 10 statements on a 5-point Likert scale on the relevance, impact, and overall satisfaction of the online module. Eighty-four of the 103 students (81.6% response rate) completed the questionnaire. While most students responded positively to the online content, pharmacy students responded more favorably compared with students from Dentistry and Dental Hygiene. These findings provide useful information to identify areas in which the web-based module can be improved for teaching skills in physical assessment across multiple healthcare programs.

Dental service utilization by independently dwelling older adults in Manitoba, Canada.

OBJECTIVES: The objectives of this study were to determine the rate of use of dental services by independently living older dentate and edentulous adults and the factors affecting utilization. METHODS: Data were derived from the cross-sectional Manitoba Study of Health and Aging. A personal interview included over 240 questions addressing sociodemographics, well-being, oral and general health, and health service utilization. Variables that were significantly associated with visitation on bivariate analysis were entered into separate logistic regressions for dentate and edentulous participants. The Anderson model of health service utilization was used to categorize variables with significant independent effects as predisposing, enabling and need factors. RESULTS: The 1,751 participants had a mean age of 76.2 years (standard deviation 7.1); 58.5% were women and 72.7% were edentulous. Only 383 participants (21.9%) reported having visited a dentist in the past 6 months. The visitation rate for dentate seniors (36.2%) was significantly higher (p < 0.001) than that for edentulous seniors (13.5%). Multiple logistic regression analysis revealed significant independent effects of 5 variables for each group. Predisposing factors predicting visitation for both groups were higher level of education and frequent use of professional services. For dentate adults, dental visitation was predicted by 3 enabling factors (main supporting person not a family member, fewer restrictions on activities of daily living and residence in a major urban centre) but no need factors. For edentulous participants, dental visitation was predicted by only 1 enabling factor (higher income) and 2 need factors (recent dental problems and longer duration of denture use). DISCUSSION: Regular dental visits are important in maintaining good health, for edentulous as well as dentate seniors. Despite this fact, older Manitobans, especially the edentulous, are not accessing care in an appropriate manner. One unexpected finding was that despite equivalent abilities, cognitive status and health problems, those who had a family member as their main supporting person were less likely to have a dental visit than those supported by non-family members. This may relate to resistance from family members to provide appropriate support for dental visits, an issue considered by some to be a form of elder abuse. CONCLUSION: Despite some common predisposing factors, the variables influencing dental utilization were different for dentate and edentulous participants, with enabling factors playing a bigger role for the dentate and need factors of greater importance for the edentulous. These findings seem to indicate that older dentate adults who visit the dentist do so because they can, while older edentulous adults who visit the dentist do so because they must.

Tobacco use cessation services provided by dentists and dental hygienists in Manitoba: part 1. Influence of practitioner demographics and psychosocial factors.

OBJECTIVE: Despite high rates of tobacco use, overwhelming evidence of detrimental effects on oral health, smokers" desire to stop using tobacco and the availability of efficacious brief intervention counselling (BIC) strategies, the delivery of cessation services by dental practitioners is, at best, inconsistent. The purpose of this part of our study was to assess BIC practice patterns among dentists and dental hygienists in Manitoba and to determine whether demographic or psychosocial factors influence BIC delivery. METHODS: A pre-piloted survey was mailed to all licensed dentists (547) and registered dental hygienists (566) in the province. RESULTS: In all, 514 oral health practitioners responded for a 46.2% response rate. Most oral health practitioners in Manitoba are not providing consistent BIC; however, 54.9% (279/508) of survey respondents advise smokers to quit. Women clinicians are more likely to ask, assess and assist patients and tend to advise against smoking more frequently than men; younger practitioners are more likely to ask and assess readiness to quit smoking than older practitioners; dental hygienists are more likely to provide assistance to quit than dentists. Assisting is the service least frequently provided by practitioners. The barriers to providing BIC are different for male and female practitioners and for dentists and dental hygienists; practitioners with more psychosocial barriers provide BIC less frequently than those reporting fewer barriers. Only 36.9% (188/510) of practitioners report feeling adequately prepared to assist smokers to quit.

Caregiver knowledge and attitudes of preschool oral health and early childhood caries (ECC).

OBJECTIVES: Prevention strategies are integral to improving the oral health for young Aboriginal children. For such to be effective, it is important to understand the social value that parents and caregivers ascribe to primary teeth. The purpose of this paper is to report caregiver knowledge and attitudes toward preschool oral health and early childhood caries (ECC) from 4 communities in Manitoba. STUDY DESIGN: Cross-sectional study, including a retrospective interview with caregivers. METHODS: Children and their main caregivers served as the sample. Preschoolers underwent a comprehensive dental screening while caregivers completed a questionnaire that explored knowledge and attitudes toward preschool dental health. Caregiver responses were matched with findings from each child's examination. RESULTS: A majority agreed that primary teeth were important, that dental disease could lead to health problems and that a first dental visit should be made by age 1. Caregivers of children with ECC were more likely to believe that caries could not affect a child's health while those who believed primary teeth are important had children with significantly less decay. CONCLUSIONS: Most caregivers believed that primary teeth are important and correctly responded to inquiries about knowledge and attitudes toward oral health. Attitudes on the importance of baby teeth and bottle feeding after one year of age, the effect of rotten teeth on childhood health and night-time nursing emerged as variables most associated with the absence/presence of ECC and deft rates. Incorporating such questioning into caries risk assessments may be a useful means to determine a child's risk for ECC.

Prevalence of early childhood caries in 4 Manitoba communities.

OBJECTIVES: Early childhood caries (ECC) is a particularly destructive form of tooth decay that afflicts young children. Although few prevalence data have been published for Manitoba, long waiting lists for treatment of ECC in hospital indicate that many children in the province suffer from this condition. The purpose of this investigation was to determine the prevalence of ECC and the oral health status of children under 6 years of age in 4 communities in Manitoba and to identify risk factors associated with ECC. METHODS: The 4 Manitoba communities were selected according to the best available data regarding the number of young children scheduled for dental treatment under general anesthesia. Two of the communities were located in the southern region of the province, and the other 2 were northern communities. In each region, one community represented a disadvantaged population in a large urban centre, whereas the other was a First Nations (on-reserve) community. The parent or guardian (primary caregiver) of each child under 6 years of age was invited to participate. After informed consent had been obtained from the caregiver, each child underwent a dental examination of the deciduous dentition, and the caregiver completed a retrospective questionnaire by interview. RESULTS: A total of 408 children and their caregivers participated in the study. The overall prevalence of ECC was 53.7%, and the prevalence was similar in all 4 communities, with no statistically significant difference in caries between the high-risk urban communities and the First Nations (on-reserve) communities. The mean number of decayed, extracted or filled teeth +/- standard deviation was 4.2 +/- 5.0. Older children were more likely to have ECC (p < 0.001), but the caregiver"s level of education was not associated with ECC prevalence (p > 0.05). Children with ECC also exhibited more plaque (p < 0.001). CONCLUSIONS: The results of this study indicate that ECC is a serious problem in Manitoba. In addition, this investigation establishes a baseline to help evaluate the effectiveness of current and future prevention initiatives in these 4 communities.

Tobacco use among young North American aboriginal athletes.

Tobacco use remains a major cause of preventable illness and death in North America. Although reported smoking rates have decreased, they remain high among the young and among Aboriginal people. As part of an oral health promotion project, a convenience sample of 163 Aboriginal athletes participating in the 2002 North American Indigenous Games completed a self-administered questionnaire addressing tobacco use and knowledge of tobacco effects. Mean age of athletes was 19.6 years (SD 7.4); most were male and Canadian citizens. Only 22 participants reported current smoking; past use of tobacco was more common, with 58 reporting a history of smoking. Although age was not associated with current smoking, older athletes were significantly more likely (p

Smoking cessation services provided by dental professionals in a rural Ontario health unit.

PURPOSE: This study was undertaken to determine what smoking cessation services dental professionals in Ontario's Wellington-Dufferin-Guelph Health Unit (WDGHU) provide before disseminating a smoking cessation information package. METHODS: Data were collected with 540 self-administered questionnaires mailed to 60 local dental offices. Replies were requested from all dentists, dental hygienists, dental assistants and other dental staff working in each dental office. RESULTS: Completed responses were obtained from 126 dental personnel in 28 (47%) of the 60 dental offices surveyed. The proportion of dental offices, dentists and hygienists providing cessation services to most patients was as follows: asking patients about tobacco-use status, 46%, 31% and 32%; advising tobacco users to quit, 46%, 32% and 29%; assessing tobacco users' interest in quitting, 46%, 25% and 19%; and assisting interested patients to quit, 25%, 6% and 13%, respectively. CONCLUSION: This survey indicates that most dental professionals in the WDGHU do not provide proven smoking cessation services. An opportunity exists to increase the proportion of dental professionals providing proven smoking cessation interventions as part of routine patient services.