A global survey of national oral health policies and its coverage for young children.

Background: There is no accessible information on countries with oral health policies. The purpose of this study was to identify World Dental Federation (FDI) member countries with oral health policies and their scope and extent of coverage of oral health care for young children. Methods: This international survey recruited chief dental officers, oral health advisors to national ministries of health, and other key informants of the 158 FDI member countries between December 2020 and December 2021. The survey tool was administered online to the study participants. Key questions explored the following outcome measures: countries with oral health policies; the thrusts of the oral health policies; policy thrusts targeting young children; and dental care plans as a component of a universal health care plan. Descriptive statistics were conducted to determine the number of countries with any of the study outcome measures and coverage per country. Results: Sixty (38%) of the 158 FDI member-countries responded to the survey. Forty-eight (55.2%) of the 60 countries had a national oral health policy document or position statement on oral health; 54 (62.1%) countries had plans on universal health care, and 42 (48.3%) included dental care within their universal health care plan. The most common policy thrusts addressing the oral health needs of children were the promotion of oral hygiene (71.7%), provision of fluoride products for children (53.3%), collaboration with primary care providers (35%), and prenatal oral health education (50%). There were differences in the scope of oral health care coverage and the coverage for young children between continents as well as between countries. Europe had many countries with children-friendly oral health policy coverage. Conclusions: About half of the surveyed countries had a national oral health policy. There were variations in the scope of oral health care coverage, particularly for young children, both between continents and among individual countries. These findings underscore the importance of understanding the landscape of oral health policies globally. Such insights can help inform targeted interventions to enhance oral health policies, thereby contributing to improved oral health outcomes on a global level.

Visit to the Dentist for Oral Health Prevention at "Age One": A proposed policy report from the Indian perspective.

Early childhood caries is a major public health issue in India. The primary reason for poor oral health in children is a lack of awareness about the role of primary teeth and the importance of an early dental visit for infants and toddlers. The primary objectives of an early dental visit are to analyze the child's risk level, provide guidance to parents regarding proper oral hygiene measures, review dietary and eating habits, provide information regarding the infectivity of dental caries, review the risks of traumatic injuries and discuss factors which affect the development of occlusion. Through this paper, we are proposing an "Age One" policy that recognizes dentists, physicians, allied health professionals, community health-care workers, and nongovernmental organizations to work toward a child's overall health as partners to achieve this goal. The expectation is that this policy will provide guidance to childcare centers, pediatric dentists, other health-care professionals, and legislators regarding oral health activities and the promotion of oral health in infants. The purpose of the policy is to lay the foundation for a lifetime of preventive education and dental care, to help ensure optimal oral health beginning in childhood and continuing through the life course.

Corrigendum: Editorial: Country profile of the epidemiology and clinical management of early childhood caries, volume II.

[This corrects the article DOI: 10.3389/fpubh.2023.1201899.].

Child dental neglect and legal protections: a compendium of briefs from policy reviews in 26 countries and a special administrative region of China.

Background: Child neglect is a public health, human rights, and social problem, with potentially devastating and costly consequences. The aim of this study was to: (1) summarize the oral health profile of children across the globe; (2) provide a brief overview of legal instruments that can offer children protection from dental neglect; and (3) discuss the effectiveness of these legal instruments. Methods: We summarized and highlighted the caries profile and status of implementation of legislation on child dental neglect for 26 countries representing the World Health Organization regions: five countries in Africa (Nigeria, South Africa, Sudan, Tanzania, Zimbabwe), eight in the Americas (Argentina, Brazil, Canada, Chile, Mexico, Peru, Unites States of America, Uruguay), six in the Eastern Mediterranean (Egypt, Iran, Libya, Jordan, Qatar, Saudi Arabia), four in Europe (Italy, Latvia, Serbia, United Kingdom), two in South-East Asia (India and Indonesia) and one country (China) with its special administrative region (Hong Kong) in the Western Pacific. Results: Twenty-five of the 26 countries have legal instruments to address child neglect. Only two (8.0%) of these 25 countries had specific legal instruments on child dental neglect. Although child neglect laws can be interpreted to establish a case of child dental neglect, the latter may be difficult to establish in countries where governments have not addressed barriers that limit children's access to oral healthcare. Where there are specific legal instruments to address child dental neglect, a supportive social ecosystem has also been built to facilitate children's access to oral healthcare. A supportive legal environment, however, does not seem to confer extra protection against risks for untreated dental caries. Conclusions: The institution of specific country-level legislation on child dental neglect may not significantly reduce the national prevalence of untreated caries in children. It, however, increases the prospect for building a social ecosystem that may reduce the risk of untreated caries at the individual level. Social ecosystems to mitigate child dental neglect can be built when there is specific legislation against child dental neglect. It may be more effective to combine public health and human rights-based approaches, inclusive of an efficient criminal justice system to deal with child dental neglect.

Five-year follow-up of an interdisciplinary oral health education program: Clinical practice behaviors in working pediatric nurse practitioners.

ABSTRACT: Many interdisciplinary oral health education programs have been implemented for pediatric primary care providers (e.g., pediatric nurse practitioner [PNP]) to raise awareness and gain skills related to the prevention of early childhood caries (ECC). However, no studies have evaluated if these educational programs provided to PNPs during their training resulted in clinical practice behavior changes. A 33-item survey was designed on a web-based platform (Survey Monkey) and distributed to 71 PNP graduates. The survey included demographics, current clinical practice, clinical practice behaviors, and perceived barriers to practice. Descriptive statistics were used to assess the survey items and thematic analyses on the open-ended questions. The survey response rate was 70% (50/71 PNPs). Most practicing PNPs were in acute care or specialty clinics (n = 33; 66%) where oral health was not part of the focused visit. Majority used knowledge learned in assessment and anticipatory guidance skills. However, only 14% of primary care providers were applying fluoride varnish with 10% billing for this procedure. Barriers to application were time, available supplies, COVID protocols, lack of support staff, or not billing due to minimal reimbursement. Many primary care-trained PNPs were practicing in acute or subspecialty areas where prevention of ECC is not viewed as part of their focused visit. Pediatric nurse practitioners working in primary care demonstrated some clinical practice changes. However, areas for improvement are time to perform a risk assessment and application of fluoride varnish, access to these supplies, and standard billing and insurance reimbursement for these preventable services.

Calibration and reliability testing of a novel asynchronous photographic plaque scoring system in young children.

OBJECTIVES: The Simplified Oral Hygiene Index for Maxillary Incisors (OHI-MIS) is a novel plaque scoring system adapted for young children. This study describes calibration training and testing used to establish the inter- and intra-rater reliability for OHI-MIS measured from clinical photographs. METHODS: Two raters from the Coordinated Oral Health Promotion Chicago (CO-OP) and one from the Behavioral EConomics for Oral health iNnovation (BEECON) randomized controlled trials (RCTs) underwent calibration with gold standard raters, followed by annual re-calibration. Raters from CO-OP also completed inter-rater reliability testing; all three raters completed intra-rater reliability testing rounds. Photographs were obtained from children aged 9-39 months. RESULTS: All three raters achieved greater than 0.77 Lin's Concordance Correlation (LCC) versus gold standard consensus during calibration. All three raters had LCC ≥0.83 at recalibration 1 year later. CO-OP trial raters scored 604 photos (151 sets of 4 photographs); mostly both raters were somewhat/very confident in their scoring (≥89%), describing the most photos as "clear" (90% and 81%). The CO-OP inter-rater LCC for total OHI-MIS score was 0.86, changing little when low quality or confidence photos were removed. All three raters demonstrated high intra-rater reliability (≥0.83). CONCLUSIONS: The OHI-MIS plaque scoring system on photos had good reliability within and between trials following protocol training and calibration. OHI-MIS provides a novel asynchronous plaque scoring system for use in young children. Non-clinicians in field or clinical settings can obtain photographs, offering new opportunities for research and clinical care.

Effectiveness of Telemedicine and Teledentistry after the COVID-19 Pandemic.

Telemedicine has become increasingly important worldwide over the last two decades. As a new field, it became known especially during the COVID-19 pandemic; this review presents fields of activity with special attention to opportunities and risks. Numerous areas of application offer the possibility for broad use in the medical and dental care landscape in diagnostics, therapy, rehabilitation, and decision advice across a spatial distance. Technical and semantic standards are required, and profiles and guidelines are increasingly defined and organized. Medical/dental consultations have been established in various regions around the world as a response to pandemic challenges and have made video and online emergency consultations possible. Telemedicine applications are already regularly used in medical/dental emergencies, regardless of the pandemic situation, both for transport by train and by plane, from which patients benefit. However, legal hurdles are often still unresolved, but infrastructure challenges both for provider, user hard- and software also complicate deployment. Problems are particularly prevalent in the absence of necessary internet coverage or among socially disadvantaged and vulnerable groups who cannot afford expensive equipment or do not know how to use the technology. Broad access must be enabled, and hardware and software interfaces and updates must be regularly checked and updated. Telemedicine might also improve access to and delivery of oral and general health care support both for rural and urban areas with low costs. Even though dentistry and many medical specialties are still performed clinically by means of practical/manual examination, there are areas of diagnostics where telemedicine applications can provide good support. Therefore, as conclusions, access, and delivery of telemedicine applications in dentistry and medicine should be expanded and improved to provide access to all population groups.

Addressing social determinants of oral health, structural racism and discrimination and intersectionality among immigrant and non-English speaking Hispanics in the United States.

BACKGROUND: The Hispanic population is the largest (18.5%) and fastest growing non-majority ethnic group in the United States (US), about half of whom are non-US born, and bears one of the highest oral disease burdens. Most current knowledge around oral health disparities in Hispanic populations examine the individual factors of culture, acculturation, and socioeconomic status. However, the root causes of this inequity; oral health literacy (OHL), social determinants of health (SDOH), structural racism and discrimination (SRD) and the intersectionality among the three, have not been well-studied. Addressing this critical gap will be central to advancing health equity and reducing oral health-related disparities in the Hispanic population, especially among immigrant and non-English speaking Hispanics. RESULTS: Recommendations for future OHL/SDOH/SRD-related research in oral health targeting Hispanic populations should include: (1) examining the direct and indirect effects of OHL/SDOH/SRD-related factors and intersectionality, (2) assessing the impact of SRD on oral health using zip-code level measures, (3) examining the role of OHL and SDOH as potential effect modifiers on the relationship between SRD and oral health outcomes, (4) conducting secondary data analysis to identify demographic, social and structural-level variables and correlations between and among variables to predict oral health outcomes, and (5) obtaining a deeper understanding of how OHL/SDOH and SRD factors are experienced among Hispanic immigrant and migrant populations. CONCLUSION: It is hoped these recommendations will lead to a better understanding of the mechanisms through which OHL, SDOH and SRD impact oral health outcomes among the largest minority population in the US so they can be addressed.

Unexpected benefits of and lessons learned from shifting to virtual focus group discussions in the BEECON trial.

OBJECTIVE: The COVID-19 pandemic has forced many human subjects research to halt in-person activities and pivot to virtual engagement, including Focus Groups (FGs). We highlight learnings from our experience of hosting virtual FGs from our BEhavioral EConomics for Oral health iNnovation (BEECON) study focusing on oral hygiene behaviors among low-income, predominantly Hispanic families, including practical tips and potential pitfalls to avoid for researchers considering virtual engagement. RESULTS: There can be particular benefits to holding virtual sessions among minority parents of young children-to provide flexibility, comfort, and reduced logistical barriers for participation-while still facilitating friendly conversation with minimal distractions. However, extensive preparation is needed to ensure smooth execution and minimal distractions.

Improved oral health knowledge in a primary care pediatric nurse practitioner program.

ABSTRACT: Pediatric nurse practitioners (PNPs) are a significant workforce in primary care and are uniquely positioned to improve oral health in children through ongoing surveillance in the well-child visit. The purpose of this study was to evaluate PNP student satisfaction and knowledge gained with the integration of the Strategic Partnership for Interprofessional Collaborative Education in Pediatric Dentistry (SPICE-PD) oral health education program into the first-year primary care curriculum. A descriptive, comparative design examined dental test scores across the pre-SPICE-PD (2013-2014; n = 26) and post-SPICE-PD (2015-2020; n = 55) cohorts. An electronic survey was completed (n = 47; 67%), and focus group (n = 12) audio-recordings were analyzed using Atlas.ti 8.0. Chi-square test and independent samples t-test were used to assess differences between groups. The SPICE-PD students reported improved knowledge and skill in clinical practice. Focus group themes were oral health education was beneficial, impact of coronavirus disease 2019, and suggestions for improvement. Mean dental test scores improved pre- and post-SPICE-PD (83 vs. 93; p < .001). The SPICE-PD oral health education improved knowledge and was highly satisfying for students. Pediatric nurse practitioners are ideally positioned to integrate oral health into primary care services, thereby improving access to care and ultimately reducing or mitigating early childhood caries. Evaluation of PNP postgraduation practices in the primary care setting is needed to assess whether improved knowledge results in practice change.

Using a Machine Learning Algorithm to Predict the Likelihood of Presence of Dental Caries among Children Aged 2 to 7.

BACKGROUND: Dental caries is the most common chronic childhood infectious disease and is a serious public health problem affecting both developing and industrialized countries, yet it is preventable in most cases. This study evaluated the potential of screening for dental caries among children using a machine learning algorithm applied to parent perceptions of their child's oral health assessed by survey. METHODS: The sample consisted of 182 parents/caregivers and their children 2-7 years of age living in Los Angeles County. Random forest (a machine learning algorithm) was used to identify survey items that were predictors of active caries and caries experience. We applied a three-fold cross-validation method. A threshold was determined by maximizing the sum of sensitivity and specificity conditional on the sensitivity of at least 70%. The importance of survey items to classifying active caries and caries experience was measured using mean decreased Gini (MDG) and mean decreased accuracy (MDA) coefficients. RESULTS: Survey items that were strong predictors of active caries included parent's age (MDG = 0.84; MDA = 1.97), unmet needs (MDG = 0.71; MDA = 2.06) and the child being African American (MDG = 0.38; MDA = 1.92). Survey items that were strong predictors of caries experience included parent's age (MDG = 2.97; MDA = 4.74), child had an oral health problem in the past 12 months (MDG = 2.20; MDA = 4.04) and child had a tooth that hurt (MDG = 1.65; MDA = 3.84). CONCLUSION: Our findings demonstrate the potential of screening for active caries and caries experience among children using surveys answered by their parents.

Association between first oral examination characteristics and dental treatment needs in privately insured children: A claims data analysis.

BACKGROUND: Early childhood caries (ECC) remains the most common, preventable infectious disease among children in the United States. Screening is recommended after the eruption of the first tooth, but it is unclear how the age at first dental examination is associated with eventual restorative treatment needs. The authors of this study sought to determine how provider type and age at first dental examination are associated longitudinally with caries experience among children in the United States. METHODS: Deidentified claims data were included for 706,636 privately insured children aged 0 through 6 years as part of the nationwide IBM Watson Health Market Scan (2012-2017). The authors used Kaplan-Meier survival analysis to describe the association between the age of first visit and restorative treatment needs. RESULTS: A total of 21% of this population required restorative treatment, and the average age at first dental examination was 3.6 years. A multivariable Cox proportional hazards model showed increased hazard for restorative treatment with age at first dental visit at 3 years (hazard ratio, 2.05; 95% CI, 1.97 to 2.13) and 4 years (hazard ratio, 3.99; 95% CI, 3.84 to 4.16). CONCLUSION: The high proportion of children requiring restorative treatment and late age at first dental screening show needed investments in educating general dentists, medical students, and pediatricians about oral health guidelines for pediatric patients. PRACTICAL IMPLICATIONS: Communicating the importance of children establishing a dental home by age 1 year to parents and health care professionals may help reduce disease burden in children younger than 6 years.

Evaluation of an interprofessional education program in pediatric dentistry, medicine, and nursing.

PURPOSE: The purpose of this study was to assess whether the Strategic Partnership for Interprofessional Collaborative Education in the Pediatric Dentistry (SPICE-PD) program at the UCLA School of Dentistry positively affected interprofessional experiences and practice patterns of pediatric and general dentistry residents, pediatric medical residents, and pediatric nurse practitioner students (PNPs). METHODS: Data collection included a year-end online survey given to participants in the interprofessional program upon graduation from their UCLA dental/medical/nursing programs. Of the 318 participants who were recruited into SPICE-PD, 208 (65%; 208/318) completed the survey. Chi-square tests were used to assess differences in key outcome variables by dental/medical specialty. RESULTS: Most dental, medical, and nursing participants thought SPICE-PD helped them learn to work more effectively with interprofessional colleagues and reported knowing more about the abilities and contributions of other health professionals as a result of the program. While most pediatric medical residents and PNPs thought SPICE-PD improved their skills to screen for early childhood caries (N = 91% and N = 100%), PNPs were more likely than pediatric medical residents to report SPICE-PD improved their skills to apply fluoride varnish (98% versus 72%; p < 0.001). Almost all pediatric medical residents and PNPs thought primary care providers should incorporate oral health into routine patient care and provide referrals to dental professionals when necessary. CONCLUSION: Increased interprofessional education and coordination of care through programs such as SPICE-PD can help bridge the gap between dental and medical care and lead to improved oral health outcomes and more comprehensive and preventive patient care.

COVID-19 Impact on Community-Based Participatory Randomized Controlled Trials-Lessons From the Oral Health Disparities in Children Consortium.

The COVID-19 pandemic has had a major impact on nearly every sector of science and industry worldwide, including a significant disruption to clinical trials and dentistry. From the beginning of the pandemic, dental care was considered high risk for viral transmission due to frequent aerosol-generating procedures. This resulted in special challenges for dental providers, oral health care workers, patients, and oral health researchers. By describing the effect that the COVID-19 pandemic had on four community-based randomized clinical trials in the Oral Health Disparities in Children (OHDC) Consortium, we highlight major challenges so researchers can anticipate impacts from any future disruptions.

A Comparison of Four Caries Risk Assessment Methods.

Introduction: Caries risk assessment (CRA) is essential as the basis for successful management of dental caries. Of the many published CRA tools, four well-known ones are CAMBRA, Cariogram, American Dental Association (ADA), and American Academy of Pediatric Dentistry (AAPD) CRAs. The predictive accuracy of CAMBRA and Cariogram CRA tools have been examined in clinical outcomes studies in thousands of patients and the tools are widely used all over the world. The purpose of the present paper is three-fold, namely (1) to briefly review, compare and contrast these four CRA methods, (2) to provide a concise method for CRA introducing a quantitative component to the CAMBRA forms (CAMBRA 123), and (3) to guide the choice of CRA methods that will support caries management decisions. Comparison of Caries Risk Assessment Methods: In the present evaluation, the above-mentioned four CRA methods for ages 0-6 years and 6 years-adult were compared using 26 hypothetical patients (13 per age group). Comparison results show that Cariogram and CAMBRA categorized patients into identical risk categories. Each of the ADA and AAPD tools gave different results than CAMBRA and Cariogram in several comparison examples. CAMBRA 123 gave the same caries risk level results as the Cariogram and the CAMBRA methods for all hypothetical patients for both age groups. Conclusions: Both the Cariogram and the CAMBRA CRA methods are equally useful for identifying the future risk of dental caries. CAMBRA 123 shows promise as an easy-to-use quantitative method for CRA in clinical practice. The health care providers will be the ones to decide which CRA method will allow them to establish individualized, successful caries management therapies and how to combine these for the best care of their patients.

Evidence-Based Caries Management for All Ages-Practical Guidelines.

Introduction: The purpose of the present paper is to provide step-by-step guidelines for dental healthcare providers to manage dental caries based upon caries risk assessment (CRA) for ages 0-6 years and 6 years through adult. The manuscript reviews and updates the CAMBRA (caries management by risk assessment) system which includes CRA and caries management recommendations that are guided by the assessed risk level. Caries Risk Assessment: CAMBRA CRA tools (CRAs) have been evaluated in several clinical outcomes studies and clinical trials. Updated CAMBRA CRAs for ages 0-6 years and 6 years through adult are provided. These CRAs have been refined by the addition of a quantitative method that will aid the health care provider in determining the caries risk of individuals. Caries Management Based Upon Risk Assessment: Guidelines for individualized patient care are provided based upon the caries risk status, results of clinical exams and responses of the patient to questions in the CRA. These guidelines are based upon successful outcomes documented in several clinical outcomes studies and clinical trials. The paper includes a review of successful caries management procedures for children and adults as previously published, with additional emphasis on correct use of silver diamine fluoride (SDF) for children. The caries management plan for each individual is based upon reducing the caries risk factors and enhancing the protective factors with the additional aid of behavior modification. Beneficially altering the caries balance is coupled with minimal intervention restorative dentistry, if appropriate. These methods are appropriate for the management of dental caries in all patients.