Effectiveness of structured comprehensive paediatric oral health education for parents of children less than two years of age in Germany.

OBJECTIVE: To examine the effectiveness of expanding and improving oral health education in a clinical setting. RESEARCH DESIGN: Controlled prospective intervention study. INTERVENTION: Structured comprehensive oral health education (SC-OHE) supported by written information. was performed by 36 clinicians in all of the 30 specialist paediatric practices in the city and the administrative district of Kassel, central Germany. PARTICIPANTS: Parents of all children attending the practices for health examinations. SC-OHE was tested in two intervention groups (IG), one with a mean child age of seven months and another with a mean child age of 24 months. The SC-OHE content was adapted to the respective age groups. Control group (CG) subjects were recruited in a similar region in northern Germany and received conventional oral health education only. This consisted of comparable topics but was less comprehensive than SC-OHE. The two IGs comprised 2,170 children; the two age-matched CGs 2,040. OUTCOME MEASURES: Parental knowledge, attitudes and behaviour relevant to decreasing the risk of early childhood caries (ECC) development. The outcomes were measured by questionnaires sent to the parents. RESULTS: The response rate was 88%. On average, control group paediatricians provided 2.1 information items at each child examination whereas the intervention group provided 3.8 items. Parental knowledge increased by 23%. Self-efficacy and attitudes remained unchanged. 41% of 7-month-olds in the CG received baby bottles with cariogenic content during daytime as opposed to 32% in the IG (p < 0.001); however, bottle use at night was unchanged. IG parents were less likely to add sugar to puréed baby food of the 7-month-olds. In 24-month-old children, the frequent consumption of cariogenic beverages in the daytime decreased slightly (CG 66%, IG 61%, p < 0.001), but five other nutritional behaviours, fluoride use and tooth brushing remained unchanged. CONCLUSIONS: Primary care providers can be trained to perform SC-OHE that improves parental oral health knowledge. SC-OHE provided by clinicians alone will not be capable of influencing crucial oral health behaviours in such a way that prevents ECC.

[Oral disease epidemiologic illness indices and oral health measures--traditional concepts are supplemented by new socio-dental indicators]. / Oralepidemiologische Krankheitsindizes und Gesundheitsmasse--traditionelle Konzepte werden durch neue soziodentale Indikatoren ergänzt.

The article describes various of the commonly used measures for oral health and disease. Their disadvantages and shortcomings are discussed, and alternative approaches are presented. It is argued that the "classical" clinical indices reflect only parts of a holistic understanding of oral health. They should be supplemented by psycho-social measures, so-called socio-dental indicators, which can be applied in epidemiological surveys as well as in the evaluation of preventive programmes.

[Sociodental indicators in children and adolescents]. / Soziodentale Indikatoren bei Kindern und Jugendlichen.

Sociodental indicators are measures for the psychological and social impact of dental diseases. They add the subjective views of patients to professionally defined clinical indices. The article describes the theoretical and empirical background for the development of those indicators and states which indicators have been used so far in Germany. Sociodental indicators may be used in oral health promotion for children and adolescents to assess their problems, to better understand their experiences and perceptions and to demonstrate the need for dental prevention to the public and financing institutions. The indicators are less suitable for planning purposes and for evaluating health promotion, because they represent effects which are too remote from the intervention itself and are influenced by too many co-factors. Finally, a conceptual framework for indicators of psychosocial impacts on children is presented.

[Managed care--a possibility for German Health Insurance?]. / Managed care--eine Perspektive für die GKV?

Health services systems in nearly all developed countries face similar problems. This fact raises the question whether concepts used in different countries can be changed without affecting the historically grown foundations of national health services as have been accepted by majority. A group of experts of the German Medical Services of the Statutory Health Insurance were asked to analyse whether the managed care approach could play a substantial role in reforming the German "Bismarck model", given that the advisory responsibility of the social medical service for the sick funds is respected in such a consideration and that basic essentials of the system are maintained. The group concludes, in brief, that managed care and the "German model" are contradictory in respect of preconditions, aims and assumed results. Furthermore, the experts share the view that the "German model" incorporates sufficient to cope with its problems without changing the nature of health services, based on principles of solidarity in Germany. The system needs structural reforms rather than changes in monetary mechanisms.