Guardian Reports of Children's Sub-optimal Oral Health Are Associated With Clinically Determined Early Childhood Caries, Unrestored Caries Lesions, and History of Toothaches

Background: Parents'/guardians' perceptions of their children's oral health are useful proxies of their clinically determined caries status and are known to influence dental care-seeking behavior. In this study, we sought to examine (1) the social and behavioral correlates of fair/poor child oral health reported by guardians and (2) quantify the association of these reports with the prevalence of early childhood caries (ECC), unrestored caries lesions and toothaches.Methods: We used guardian-reported child oral health information (dichotomized as fair/poor vs. excellent/very good/good) obtained via a parent questionnaire that was completed for n = 7,965 participants (mean age = 52 months; range = 36-71 months) of a community-based, cross-sectional epidemiologic study of early childhood oral health in North Carolina between 2016 and 2019. Social, demographic, oral health-related behavioral data, and reports on children's history of toothaches (excluding teething) were collected in the same questionnaire. Unrestored ECC (i.e., caries lesions) was measured via clinical examinations in a subset of n = 6,328 children and was defined as the presence of one or more tooth surfaces with an ICDAS ≥ 3 caries lesion. Analyses relied on descriptive and bivariate methods, and multivariate modeling with average marginal effect (A.M.E.) estimation accounting for the clustered nature of the data. Estimates of association [prevalence ratios (PR) and adjusted marginal effects (AME) with 95% confidence intervals (CI)] were obtained via multilevel generalized linear models using Stata's svy function and accounting for the clustered nature of the data.Results: The prevalence of fair/poor oral health in this sample was 15%–it increased monotonically with children's age, was inversely associated with parents' educational attainment, and was higher among Hispanics (21%) and African Americans (15%) compared to non-Hispanic whites (11%). Brushing less than twice a day, not having a dental home, and frequently consuming sugar-containing snacks and beverages were significantly associated with worse reports (P < 0.0005). Children with fair/poor reported oral health were twice as likely to have unrestored caries lesions [prevalence ratio (PR) = 2.0; 95% confidence interval (CI) = 1.8-2.1] and 3.5 times as likely to have experienced toothaches [PR = 3.5; 95% CI = 3.1-3.9] compared to those with better reported oral health.Conclusions: Guardian reports of their children's oral health are valuable indicators of clinical and public health-important child oral health status. Those with fair/poor guardian-reported child oral health have distinguishing characteristics spanning socio-demographics, oral-health related practices, diet, and presence of a dental home.

902Effect modification by homeownership in the relationship between household income and child oral health

Background Poor oral health among children is socially patterned and poorly understood. To optimise interventions aimed at reducing the persistent socioeconomic gap in health, we need to understand its shaping mechanisms. We examined if homeownership modifies the widely recognised association between household income and child oral health. Methods Data were analysed on 3,344 children from the Longitudinal Study of Australian Children. Multivariable regression models tested associations between tertiles of household income and dental decay and tooth loss. Effect modification by homeownership was tested on both additive and multiplicative scales. Models were adjusted for demographic variables, area of residence and family characteristics. Results For dental decay and tooth loss, children in households in the lower tertiles of income had worse oral health than children in the highest. Additive interaction was weakly supported in our models. The relative effect of income on oral health was greater for homeowners than renters for dental decay (medium household income 0.65 (95%CI: 0.44; 0.98) and low household income 0.82 (95%CI: 0.58; 1.15)) and tooth loss (medium household income 0.25 (95%CI: 0.09; 0.68) and low household income 0.41 (95%CI: 0.17; 0.97)). Conclusions Low-income children have poorer oral health outcomes. Although children of homeowners have better oral health than children of renters, income inequality is higher among the homeowner’s group. Current rent assistance programs for low-income families in Australia may minimise income-related inequalities on a relative scale. Key messages Our findings shed light on the potential of equalising policies in reducing income-related oral health inequalities.

Comparison of a full arch digital photographic assessment of caries prevalence in 5-year-old children to an established visual assessment method: a cross-sectional study

Introduction Digital epidemiology in dental disease screening has a number of advantages which warrant further exploration. Aim This study aimed to test the examination accuracy of digital images to evaluate child oral health by comparing the new method to a gold standard method. It also investigated the levels of diagnostic accuracy between different examiners, including dental care professionals and a lay examiner, when quantifying dental disease using images. Methods A calibrated dental examiner inspected forty 5-year-olds. In addition, three sets of digital images were taken per child. These images were assessed by six examiners. Sensitivity and specificity of caries diagnosis and inter-examiner reliability were calculated to compare the caries scores derived from examination of the images to those of the gold standard examinations. Results The mean values for sensitivity and specificity scores were 48.0% and 99.1%, respectively. The mean value for kappa showed moderate agreement between 0.43 and 0.73 (0.57). Mean values for agreement using intra-class coefficients were excellent (0.78) and good (0.73) for dt and dmft, respectively. No statistical difference in the validity of the caries scores was shown between the different image assessors. Conclusions These data demonstrate the feasibility of using digital images to screen child oral health and for nondental professionals to be recruited to carry out digital epidemiology for the oral health surveillance of children.

Breastfeeding and Child Oral Health Promotion: Perspectives of Nursing Mothers and Dentists

Background: The aim of this study was to analyze the knowledge and practices of dentists regarding breastfeeding as a strategy for promoting children's oral health. It also aimed to investigate how nursing mothers perceive the participation of dentists in actions to promote and support breastfeeding. Methods: this study employed a mixed methodological approach. During the quantitative phase, 91 dentists of the Family Health Strategy answered an electronic questionnaire, and the data were analyzed using descriptive statistics. For the qualitative investigation, were interviewed 21 nursing mothers. These interviews were examined through content analysis, and the results were interpreted from the perspective of the Theory of Planned Behavior. Results: Among dentists, 81.3% agreed that they are aware of the implications of breastfeeding for the child's oral health and reported 72.8% advising mothers and pregnant women about its benefits. Ambivalent social norms and weaknesses related to actions promoting and supporting breastfeeding emerged in the speeches of nursing mothers, and unfamiliarity about the benefits of this practice for children's oral health. Conclusions: Dentists recognize the benefits of breastfeeding for children's oral health. On the other hand, the nursing mothers pointed out barriers, exposed weaknesses, and signaled necessary conjunction of efforts to improve maternal and child care quality.

A systematic review of the quality and scope of decision modelling studies in child oral health research

Background Decision analytic models are often used in economic evaluations to estimate long-term costs and effects of treatment which span beyond the time-frame of a clinical trial, therefore providing a better understanding of the long-term implications of decisions that conventional trial-based economic evaluations fail to provide. This is particularly relevant for considering oral health interventions in children as treatments may affect adult oral health. However, in the field of child oral health there has not been an evaluation of the quality and scope of decision analytical models which extend into adulthood. The aim of this review is to examine the scope and quality of decision modelling studies, with horizons extending into adulthood, within the field of child oral health. Methods The following databases were searched: NHS Economic Evaluation Database (CRD York), MEDLINE, EMBASE, CINAHL, Web of Science, Scopus, the Cochrane Library and Econlit. Full economic evaluations, in the field of child oral health, published after 1997 which included a decision model with a horizon that extended beyond the age of 18 years old were included. Included studies were appraised against the Drummond checklist and the Consolidated Health Economic Evaluation Reporting Standards by calibrated reviewers. Results Four hundred studies were identified, of which nine met the inclusion criteria. Of the nine, eight were cost-effectiveness models. The majority focussed on the prevention or management of dental caries. The mean percentage of applicable Drummond checklist criteria met by the studies in this review was 82% (median = 85%, range = 54–100%). Discounting of costs and performing an incremental analysis were noted as key methodological weaknesses. The mean percentage of applicable CHEERS criteria met by each study was 82% (median = 87%, range = 32–96%). Justifying the type of model, analytical methods used, and sources of funding were most commonly unreported. Conclusions There is a paucity of decision analytical models in the field of child oral health. Most of those that are available are of high methodological and reporting quality.

An Indonesian Version of Child Oral Health Impact Profile-Short Form 19 (COHIP-SF19): Assessing Validity and Reliability

Previous surveys have indicated that the majority of Indonesian children have poor oral health. However, scant information is available on children’s oral health related quality of life (OHRQoL). The purpose of this study was to assess reliability as well as discriminant and convergent validity of Child Oral Health Impact Profile-Short Form 19 (COHIP-SF 19) Indonesian version. Methods: The Indonesian version of COHIP-SF 19 was developed according to the guidelines for the cross-cultural adaptation process. The instrument was tested among 529 children between 12 – 15 years old who were randomly selected from six junior high schools in Jakarta. The psychometric testing included internal consistency reliability, test-retest reliability, discriminant validity, and convergent validity. Results: Mean age of the participants was 13.3±0.9 years and 54% of the participants were female. The mean COHIP-SF 19 score was 57.8±8.8 and the median was 58 (range 27 – 75). The internal consistency and test-retest reliability was excellent for COHIP-SF 19 score with Chronbach’s alpha 0.83 and intra-class correlation coefficient 0.81. Children with active decay, untreated caries with pulpal involvement, and gingivitis had significantly lower COHIP-SF 19 scores (p-value ≤ 0.030). Correlation between COHIP-SF 19 score, subscale scores and clinical severity as well as self-rated general or oral health were very low to low (rs = 0.04 – 0.27, p-value ≤ 0.028), after adjustment for children’s age and gender. Conclusions: The Indonesian version of COHIP-SF 19 was successfully developed to be used as an OHRQoL instrument for Indonesian school-age children. The internal consistency, test-retest reliability, discriminant validity, and convergent validity of COHIP-SF 19 Indonesian version were confirmed

Μελέτη της συμπεριφοράς ατόμων με αναπηρία και των φροντιστών τους απέναντι στην προτεινόμενη οδοντιατρική θεραπεία

Με τη συγκεκριμένη έρευνα, επιχειρείται μία σχοινοτενής διερεύνηση και πραγμάτευση της συμπεριφοράς των ατόμων με αναπηρία και των φροντιστών τους (μαθητών, γονέων, κηδεμόνων, εκπαιδευτικών) απέναντι στην προτεινόμενη οδοντιατρική θεραπεία. Εν προκειμένω, καθίσταται μία προσπάθεια ιχνηλάτησης και κατανόησης των μεταβλητών, που επενεργούν καταλυτικά στη στάση και συμπεριφορά των ατόμων με αναπηρία και των φροντιστών τους. Στην εμπειρική έρευνα που διεξήχθη τα σχολικά έτη 2018-2019 και 2019-2020 έλαβαν μέρος εκατόν ενενήντα επτά (197) άτομα (μαθητές, γονείς, κηδεμόνες, νηπιαγωγοί, δάσκαλοι, καθηγητές) που αποτελούν μέλη λειτουργίας των ΣΜΕΑΕ («Ειδικά Νηπιαγωγεία, Ειδικά Δημοτικά, Ειδικά Γυμνάσια και Λύκεια και Ε.Ε.Ε.Ε.Κ. (Εργαστήρια Ειδικής Επαγγελματικής Εκπαίδευσης και Κατάρτισης»). Ως εργαλείο έρευνας χρησιμοποιήθηκε το ερωτηματολόγιο, το οποίο σχεδιάστηκε, συντάχθηκε και εκπονήθηκε από τον ερευνητή στη λογική αντίστοιχων διεθνών (Oral Health Impact Profile, Child Oral Health Quality of Life, Parental-Caregiver Perceptions Questionnaires, Oral Health Index) που δίνονται προς συμπλήρωση στους φροντιστές των ατόμων με αναπηρία, όταν καταφεύγουν στις οδοντιατρικές μονάδες και κλινικές, προκειμένου να εξεταστούν ώστε να ακολουθήσουν την προτεινόμενη οδοντιατρική θεραπεία. Τα εμπειρικά ευρήματα και εκβάσεις, καταληκτικά, κατάδειξαν ότι η κακή κατάσταση της στοματικής κοιλότητας των ατόμων με αναπηρία, επηρεάζει ελάχιστα τη γνωστική τους απόδοση, τον ύπνο τους, τη μάσηση των τροφών και το συναισθηματικό και συμπεριφορικό τους προφίλ κατά τη διάρκεια της σχολικής τους καθημερινότητας και ζωής.