Changes in toothbrushing frequency in relation to changes in oral health‐related knowledge and attitudes among children – a longitudinal study

Tolvanen M, Lahti S, Hausen H. Changes in toothbrushing frequency in relation to changes in oral health‐related knowledge and attitudes among children – a longitudinal study. Eur J Oral Sci 2010; 118: 284–289. © 2010 The Authors. Journal compilation © 2010 Eur J Oral Sci The aim of this study was to determine the associations between changes in self‐reported toothbrushing frequency and the knowledge and attitudes related to oral health. The study population consisted of all fifth and sixth graders who started the 2001–2002 school year in Pori (n = 1,691); of these, 1,362 were monitored throughout the 3.4‐yr study. Data were gathered by questionnaires before, in the middle, and after the follow‐up, which was divided into two periods. Associations between changes in toothbrushing frequency, sum score of knowledge items, and sum scores of items in attitudinal factors were studied. The attitudinal factor structure was determined by principal component analyses. The associations were evaluated using mean values and general linear models for repeated measures. Toothbrushing frequency and knowledge and attitudes related to oral health improved among the same children during the study, with the changes usually taking place in the same time‐period. In different time‐periods, different children’s toothbrushing and oral health‐related knowledge and attitudes improved. Based on our results, changes in knowledge, attitudes, and behavior are related, but children are ready for change at different times. Therefore, oral health promotion should be designed to be a continuous process rather than a short‐term intervention.     

Dental hygienists’ views on communicative factors and interpersonal processes in prevention and treatment of periodontal disease

To cite this article:
Int J Dent Hygiene 8, 2010; 213–218
DOI: 10.1111/j.1601‐5037.2010.00459.x
Stenman J, Wennström JL, Abrahamsson KH. Dental hygienists’ views on communicative factors and interpersonal processes in prevention and treatment of periodontal disease. Abstract: Objective: The aim of this study was to explore views of DHs on communicative issues and interpersonal processes of importance in the prevention and treatment of periodontal disease. Method: The qualitative method of Grounded Theory (GT) was chosen for data sampling and analysis. Audio‐taped and open‐ended interviews were conducted with 17 dental hygienists. The interviews were transcribed verbatim and analysed in a hierarchical coding process, according to the principles of GT. Result: In the analysis a core category was identified as ‘to be successful in information and oral health education and managing desirable behavioural changes’. The core concept was related to four additional categories and dimensions; (i) ‘to establish a trustful relationship with the patient’, (ii) ‘to present information about the oral health status and to give oral hygiene instructions’, (iii) ‘to be professional in the role as a dental hygienist’ and (iv) ‘to have a supportive working environment in order to feel satisfaction with the work and to reach desirable treatment results’. Conclusion: The results describe a psychosocial process that elucidates the importance of building a trustful relationship with the patient, feeling secure in one’s professional role as a DH and last but not least, the importance of having support from colleagues and the clinical manager to be successful in the prevention and treatment of periodontal diseases.     

Attitudes towards oral health among parents of 6‐year‐old children at risk of developing caries

Vermaire JH, Hoogstraten J, van Loveren C, Poorterman JHG, van Exel NJA. Attitudes towards oral health among parents of 6‐year‐old children at risk of developing caries. Community Dent Oral Epidemiol 2010; 38: 507–520. © 2010 John & Wiley & Sons A/S Abstract – Objectives: Parental attitudes are likely to play a role in achieving and maintaining a desired level of oral health in children. To be useful in individually delivered caries prevention programmes, parental attitudes should be identified at individual level. Q‐methodology has been proved successful in identifying attitudes in a wide range of disciplines but in dentistry Q‐studies are scarce. In this study Q‐methodology was used to identify parents’ prevailing attitudes towards the oral health of their children. Methods: Thirty‐nine parents ranked 37 statements regarding the dental health behaviour they apply to their 6‐year‐old child. They later explained their rankings during a short interview. In Q‐methodology, rather than reporting one average composite attitude and opinion, various combinations of opinions and attitudes concerning these statements are identified using by‐person factor analysis. Results: Based on their beliefs, attitudes and cognitions, five categories of parents were found: (i) conscious and responsible, (ii) trivializing and fatalistic, (iii) appearance‐driven and open‐minded, (iv) knowledgeable but defensive and (v) conscious and concerned. Conclusions: Q‐methodology appears to be a fruitful way to structure the complexity of parents’ opinions and attitudes towards their children’s dental health. It appears that Q‐methodology provides comprehensive clusters of individual attitudes, based on various levels of responses to a wide range of questions. The five identified profiles may be useful in developing tailor‐made prevention strategies in caries prevention.     

The oral‐systemic personalized medicine model at Marshfield Clinic

Oral Diseases (2012) 19 , 1–17 Periodontal disease and diabetes, two diseases that have achieved epidemic status, share a bidirectional relationship driven by micro‐inflammatory processes. The present review frames the current understanding of the pathological processes that appear to link these diseases and advances the hypothesis that reversal of the epidemic is possible through application of interdisciplinary intervention and advancement of oral‐systemic personalized medicine. An overview of how Marshfield Clinic’s unique clinical, informatics and bio‐repository resources and infrastructures are being aligned to advance oral‐systemic personalized medicine is presented as an interventional model with the potential to reverse the epidemic trends seen for these two chronic diseases over the past several decades. The overall vision is to engineer a transformational shift in paradigm from ‘personalized medicine’ to ‘personalized health’.     

Oral health status of rural–urban migrant children in South China

International Journal of Paediatric Dentistry 2011; 21: 58–67 Background. In China, there is a massive rural–urban migration and the children of migrants are often unregistered residents (a ‘floating population’). Aim. This pilot study aimed to profile the oral health of migrant children in South China’s principal city of migration and identify its socio‐demographic/behavioural determinants. Design. An epidemiological survey was conducted in an area of Guangzhou among 5‐year‐old migrant children (n = 138) who received oral examinations according to the World Health Organization criteria. Parents’ oral health knowledge/attitude, child practices, and impact of children’s oral health on their quality‐of‐life (QoL) were assessed. Results. The caries rate and mean (SD) dmft were 86% and 5.17 (4.16), respectively, higher than those national statistics for both rural and urban areas (P < 0.05). Oral hygiene was satisfactory (DI‐S < 1.0) in 3% of children. Oral health impacts on QoL were considerable; 60% reported one or more impacts. 58% variance in ‘dmft’ was explained by ‘non‐local‐born’, ‘low‐educated parents’, ‘bedtime feeding’, ‘parental unawareness of fluoride’s effect and importance of teeth’, and ‘poor oral hygiene’ (all P < 0.05). ‘Non‐local‐born’ and ‘dmft’ indicated poor oral health‐related QoL (both P < 0.05), accounting for 32% of variance. Conclusion. Oral health is poor among rural–urban migrant children and requires effective interventions in targeted sub‐groups.     

Commentary on the article ‘Understanding Muslim patients: cross‐sectional dental hygiene care’

I have read with interest the article ‘‘Understanding Muslim patients: cross‐sectional dental hygiene care’’ by ML Sirois et al. In the time that I see their article as a faithful, unbiased image showing a Muslim's religious life and conduct from the oral and systemic health perspective, I still have two main concerns about certain facts which were denoted with imprecise connotations. These are related to food and Ramadan fasting.     

Oral health behaviors of preschool children with cerebral palsy: a case‐control community‐based study

To describe and compare the oral health behaviors of preschool children with and without cerebral palsy (CP), and to assess the oral health knowledge and attitudes of their primary caregivers (PCGs). Seventy‐two preschool children with CP were recruited from 23 Special Child Care Centers in Hong Kong. An age‐ (±3 months) and gender‐matched sample of children from mainstream preschools was recruited as a “control group.” Assessment of children's oral health behaviors and the PCGs' oral health knowledge and attitudes was conducted using questionnaires. Preschool children with CP were less likely to have ever attended a dentist (p < 0.05). Tooth brushing frequency was similar between the two groups (p > 0.05), but PCGs of children with CP more frequently reported provision of tooth brushing assistance to their children (p < 0.001). PCGs in both groups had similar oral health knowledge and attitudes (p > 0.05). Difference in oral health behaviors existed between preschool children with and without CP. PCGs of children with and without CP had similar oral health knowledge and attitudes.     

Outcome of an oral health outreach programme for preschool children in a low socioeconomic multicultural area

Background. Despite a significant reduction in the prevalence of dental caries, childhood tooth decay is still a public health problem in both developed and developing countries. Objective. The aim of this study was to evaluate the caries preventive effect of an oral health programme for preschool children living in a low socioeconomic multicultural area in the city of Malmö, Sweden. Methods. Eight hundred and four 2‐year‐old children were enrolled and recalled every third month between ages 2 and 3 and semi‐annually between ages 3 and 5 years. From an outreach facility, parents were instructed on oral health with a focus on toothbrushing and diet, and provided fluoride tablets free of charge. Participants completed a clinical examination and a structured interview at age of 5 years, at which point 651 children (81%) remained in the programme. The results of the intervention group were compared with a non‐intervention reference group consisting of 201 5‐year‐old children from the same district. Results. In the intervention group, 96% attended four or more of their scheduled appointments, and mean caries prevalence was significantly lower than in the reference group (5.4 deft vs. 6.9 deft; P < 0.001). The prevented defs fraction was 27%. Parents’ daily assistance with toothbrushing and administering fluoride tablets was significantly better in the intervention group than in the reference group (P < 0.05). Conclusion. This study demonstrated that the early start of oral health programme had a significant beneficial effect on caries prevalence after 3 years.     

The invisible work with tobacco cessation - strategies among dental hygienists

To cite this article:
Int J Dent Hygiene 10 , 2012; 54–60
DOI: 10.1111/j.1601‐5037.2011.00530.x
Andersson P, Westergren A, Johannsen A. The invisible work with tobacco cessation – strategies among dental hygienists. Abstract: Objective: This study elucidates dental hygienists’ experiences of work with tobacco cessation among patients who smoke or use snuff. Methods: Data were obtained and categorized by interviewing 12 dental hygienists, who worked actively with tobacco cessation interventions. Qualitative content analysis was used for analysis. Results: The latent content was formulated into the core category ‘the invisible oral health promotion work’. The informants thought that they had a responsibility to work with tobacco cessation. They perceived the financial system in which they perform the activity as frustrating, because tobacco cessation has no treatment code in the dental care insurance. This was one of several reasons why they had to integrate it in other treatment procedures. The results identified three categories: ‘balance in the meeting’, ‘possibilities and hindrance’ and ‘procedures’. In the narratives, both positive and negative aspects were displayed. Conclusions: The financial conditions for tobacco cessation interventions need to be reformed and the activity has to be given a higher priority in the organization of dental care. Practical training in performing tobacco cessation interventions is important during the dental hygiene education; otherwise, tobacco cessation interventions will remain invisible in oral health promotion in the future.     

Oral health‐related quality of life and its relationship with health locus of control among Indian dental university students

Objectives: The objectives of this study were to assess the relationship between Oral Health‐Related Quality of Life (OHRQoL) and Health Locus of Control (HLC) among students in an Indian dental school. Materials and methods: A cross sectional study design was used. Three hundred and twenty‐five dental students returned completed forms containing the 14 item Oral Health Impact Profile (OHIP‐14) and the 18 item Multidimensional Health Locus of Control Scale (MHLC). Results: The results showed that the perceived OHRQoL differed among students studying in different stages of the dental course. The OHRQoL dimensions of ‘Social Handicap’ and ‘Handicap’ were significantly (P < 0.01) lower among the later years of the course than the freshman year students. There was a sharp increase in Self‐reported dental problems, in particular, Malocclusion, Tooth decay, Calculus among the third year and final year students respectively. The OHIP‐14 scores were significantly higher among those with self‐reported oral problems. Correlation analysis between the OHIP‐14 and the MHLC scores also showed a statistically significant (P < 0.01) correlation between the ‘Chance’ dimension of the MHLC and OHIP‐14 scores. Conclusions: The results of this study underscored the relationship between the OHRQoL and HLC and of importance of assessing health attitudes and their impact on OHRQoL among the dental student community.     

Preference for dentist's home visits among older people

Komulainen K, Ylöstalo P, Syrjälä A‐M, Ruoppi P, Knuuttila M, Sulkava R, Hartikainen S. Preference for dentist’s home visits among older people. Community Dent Oral Epidemiol 2012; 40: 89–95. © 2011 John Wiley & Sons A/S Abstract – Objectives: To investigate factors associated with older people’s preference for a dentist’s home visit. Methods: This is a report on 321 home‐dwelling participants (mean age 81.6) in the population‐based Geriatric Multidisciplinary Strategy for Good Care of the Elderly (GeMS) study, conducted in 2004–2005 in the city of Kuopio in eastern Finland. The information about sociodemographic and general health‐related factors and the use of social and health services was collected by two study nurses using a structured interview. Each study subject was given a clinical oral examination and an interview about oral health and the use of dental health care services by one of two dentists. Logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI). Results: Of the study subjects, 25.9% preferred a dentist’s home visit. The preference for choosing a dentist’s home visit was associated with a low score (≤24) in the Mini‐Mental State Examination, OR 6.1 (CI: 2.9–13.6), and a low score (<8) on the scale of Instrumental Activities of Daily Living, OR 8.0 (CI: 3.6–18.6). It was also associated with living alone, OR 5.9 (CI: 2.7–13.0), and high use of home care services, OR 9.3 (CI: 4.6–19.0). Conclusions: The findings of this study emphasize the need to organize dentists’ home visits in order to increase equality in the use of dental health care services among the older people with disabilities.     

Oral health education for schoolchildren: a qualitative study of dental care professionals' view of knowledge and learning

Abstract: Aim: The aim of the study was to describe and interpret dental professionals’ view of knowledge, learning, health promotion and their expectations of and attitudes to the response from schoolchildren. Methods: A qualitative study design was used with discourse method. Nine dental hygienists and dental nurses, who have practised oral health education among schoolchildren, described their work in tape‐recorded, semi‐structured interviews. The discourse method stresses the variation and distinctions in the statements, and to understand the content of the text, its contextual dependence must be taken into account. Results: The preventive discourse could be found in all interviews, but it was concentrated on disease prevention and less on maintaining health. The biomedical view of knowledge dominated. Children’s and parent’s own responsibility for healthy habits was stressed, but no reflection of ethical considerations associated with influencing people’s life‐style was found. The text revealed discrepancy between the informants, and even within the same individual, showing ambivalence towards oral health education. Some individuals suggested lessons guided by communication with the children, while others wanted to maintain methods based on information about oral diseases to a greater extent. Conclusions: Different perspectives were found. The expression ‘oral health promotion’ was frequently used and supported by all the interviewed informants, but the statements did not reveal the informant’s definition of the concept. Several educators focused on signs of diseases and less on the individual’s view of their own health. In the future, oral health education programme needs to focus on quality of life, behavioural variables and indicators of empowerment rather than just disease outcomes.     

Comparison of utility weighted DMFT with patient‐reported oral well‐being

This study investigated a method of measuring oral health, as opposed to measuring disease. The objective was to compare DMF score and whole mouth utility scores to a patient‐reported outcome measure (PROM). Disutility values for lost and restored teeth were used to weight the decayed, missing and filled teeths(DMFTs) of 10 adult patients. This gave two whole mouth utility scores (WMU). These scores were then compared with a patient‐reported oral health outcome measure recorded by the use of a visual analogue scale (VAS). The anchors for the VAS were ‘my mouth could not be worse’ and ‘my mouth could not be better’. There was a positive correlation (r = 0·6457) between WMU1 and the patient‐reported outcome measure (P < 0·05) and a negative correlation (r = ?0·8383) between WMU1 and DMFT which was significant at the P < 0·01 level. There was a statistically significant positive correlation of r = 0·7926 between WMU2 and the patient‐reported outcome measure (P < 0·01) and a negative correlation (r = ?0·9393) between WMU2 and DMFT (P < 0·01). The Pearson's correlation between DMFT and the patient‐reported outcome measure was ?0·8757, which was significant at the 0·01 level. Patient reports of their perceived level of health correlate well with DMFT scores. Weighting DMFT scores according to the differential values assigned to missing, or missing and filled, teeth does not increase the degree of correlation between the measure and the patients’ personal quantification of their oral health. Decayed, missing and filled teeth therefore seems to adequately capture the patient's sense of well‐being.     

Risk factors associated with symptoms of temporomandibular disorders in a population of 50- and 60-year-old subjects

summary The aims of this study were first to investigate, by means of a mail questionnaire, variables from three domains: (i) socio‐economic attributes; (ii) general and oral health; and (iii) dental attitudes and behaviours in a large sample of 50‐ and 60‐year‐old subjects, and second to compare subjects with or without reported temporomandibular joint (TMJ) pain with respect to these variables. In 2002, a questionnaire was mailed to all 50‐ and 60‐year‐old subjects in two Swedish counties, Örebro and Östergötland (n = 17 138; n₅₀ = 8878; n₆₀ = 8260). Individuals not responding within 2 weeks were given a reminder. If still not answering, a new questionnaire was sent. The final response rate was 72·8% (n = 12 468). The reported responses to questions regarding ‘pain in the TMJ region’ and ‘difficulty to open the mouth wide’ were dichotomized into two groups: (i) no temporomandibular disorders (TMD) symptoms; and (ii) some, rather great or severe TMD symptoms. Striking differences in demographic, occupational, general and oral health conditions were found between the groups with and without TMD symptoms. The strongest risk indicator for both pain and dysfunction was reported bruxism. Women, younger subjects (50 years old) and blue‐collar workers were significantly more prevalent in the TMD symptom groups. Variables related to impaired general and oral health were more common in the groups with reported TMD problems, whereas satisfaction with received dental care and with teeth was lower. Individuals with reported TMD symptoms differed significantly from those without TMD symptoms in socio‐economic attributes, general and oral health symptoms, dental conditions and satisfaction with their teeth.     

Dental fear and anxiety and oral health behaviour in 12‐ to 14‐year‐olds born preterm

International Journal of Paediatric Dentistry 2010; 20: 391–399 Background. An enhanced frequency of cognitive and behavioural disturbances has been reported in preterm children. It is not known if this affects their perceptions of or behaviour in the dental care situation. Hypothesis. The hypotheses were that preterm (PT) children aged 12–14 years more often exhibit dental fear and anxiety (DFA) than full‐term controls (C), while no differences were expected regarding oral health behaviour. Methods. One hundred and nine PT and 108 C children took part in the present questionnaire study. DFA was assessed using the Children’s Fear Survey Schedule – Dental Subscale (CFSS‐DS). In addition the questionnaire covered items including satisfaction with received dental care, oral health behaviour and medical health. Results. The children’s CFSS‐DS scores revealed no differences between the PT and C groups. Regarding oral health behaviour there were no differences, except that PT children more often used dental floss and extra fluoride supplements. PT children reported more medical health problems than C children. Conclusions. Preterm (PT) children 12‐ to 14‐years‐old, as well as C of same age group, seem to be satisfied with their dental care and display low prevalence of DFA. Still, a higher frequency of medical health problems in the PT children suggests that these children should be regarded as potential risk patients for oral health problems.     

A comparative study of oral health knowledge,attitude and behaviour of non‐medical,para‐medical and medical students in Udaipur city,Rajasthan, India

To cite this article:
Int J Dent Hygiene
DOI: 10.1111/j.1601‐5037.2009.00393.x
Sharda AJ, Shetty S. A comparative study of oral health knowledge, attitude and behaviour of non‐medical, para‐medical and medical students in Udaipur city, Rajasthan, India. Abstract: Aim: The aim of the study was to assess and compare the Oral health knowledge, attitude and behaviour of the non‐medical, para‐medical and medical students. Material and methods: In a cross‐sectional study, a total of 825 students (males – 577, females – 248) of six different professions belonging to non‐medical, para‐medical and medical categories were surveyed using a self‐administered, structured questionnaire pretested through a pilot survey. The mean percentage scores, standard deviation and frequency distribution were calculated. The Student’s t‐test, anova test, Scheffe’s test and chi‐squared test were used as test of significance. The linear regression analysis was used to assess the relation of behaviour with knowledge and attitude. Results: The knowledge scores were significantly higher for the medical students compared with those of non‐medical students. The attitude scores were significantly lower for the non‐medical category compared with the other two categories and the scores were the highest among the para‐medical students. The behaviour scores were significantly lower for the non‐medical students than for the para‐medical and the medical categories. All the scores were significantly higher for females than for the males. Regression analysis showed a linear relationship of behaviour with the attitude, but no significant linear relation with the knowledge. Conclusion: All the students showed low level of knowledge and the preventive behaviour among the students could still be improved. The results indicate that the knowledge was not enough to influence the oral health behaviour, but behaviour showed linear relationship with attitude of the students.