Although oral health care is a vital component of overall health, it remains one of the greatest unattended needs among the disabled. The aim of this study was to assess the oral health status and oral health-related quality of life (Child-OIDP in 11-13-year-old) of the visually challenged school attendants in Khartoum State, the Sudan.
A school-based survey was conducted in Al-Nour institute [boys (66.3%), boarders (35.9%), and children with partial visual impairment (PVI) (44.6%)]. Two calibrated dentists examined the participants (n=79) using DMFT/dmft, Simplified Oral Hygiene Index (OHI-S), dental care index, and traumatic dental injuries (TDI) index. Oral health related quality of life (C-OIDP) was administered to 82 schoolchildren.
Caries experience was 46.8%. Mean DMFT (age≥12, n=33) was 0.4 ± 0.7 (SiC 1.6), mean dmft (age<12, n=46) was 1.9 ±2.8 (SiC 3.4), mean OHIS 1.3 ± 0.9. Care Index was zero. One fifth of the children suffered TDI (19%). Almost one third (29%) of the 11–13 year old children reported an oral impact on their daily performances. A quarter of the schoolchildren (25.3%) required an urgent treatment need. Analysis showed that children with partial visual impairment (PVI) were 6.3 times (adjusted) more likely to be diagnosed with caries compared to children with complete visual impairment (CVI), and children with caries experience were 1.3 times (unadjusted) more likely to report an oral health related impact on quality of life.
Visually impaired schoolchildren are burdened with oral health problems, especially caries. Furthermore, the 11-13 year olds' burden with caries showed a significant impact on their quality of life.
Visually impaired children; Oral health; Oral health-related quality of life
To assess factors influencing the distribution of oral manifestations in HIV/AIDS-infected children attending the Paediatric Infectious Disease Clinic in Mulago Hospital, Kampala.
This was a cross-sectional study comprising 237 children (males/females: 113/124) aged 1 to 12 years. The parents/guardians were interviewed to obtain demographic information, oral hygiene practices, dietary habits and health seeking behaviours as well as any medications taken. The children were clinically examined for oral lesions based on World Health Organization criteria with modifications.
About 71.7% of the children cleaned their teeth. About 16.9% of the children had visited a dentist since birth, mainly for emergency care. One or more oral lesions were recorded in 73% of the children of whom 19.0% experienced discomfort during oral functions. Cervical lymphadenopathy, oral candidiasis and gingivitis were the most common soft tissue oral lesions: 60.8%, 28.3% and 19.0%, respectively. Except for dental caries, the overall frequency distribution of soft tissue oral lesions was significantly lower in children on highly active antiretroviral therapy (HAART) as compared to their counterparts not on HAART. The prevalence of dental caries in deciduous and permanent dentitions was 42.2% and 11.0%, respectively. Tooth brushing and previous visits to the dentist were indirectly and significantly associated with dental caries. About 5.9% (n=14) of the children had <200 CD3 + CD4 T-lymphocyte cells per μl of blood.
The majority of the children had one or more oral lesions, particularly in the group not on HAART. Some of the lesions were associated with discomfort during oral functions.
HIV/AIDS-infected children; Oral manifestations; Uganda
Little research has been carried out on whether the parental stress affects children’s oral health in general and dental caries in particular. This study aimed to investigate the association between parental stress and early childhood caries (ECC).
A cross-sectional study was designed that included 250 children of 4-6 year-old; 127 ones attended the pediatric department of Isfahan School of Dentistry who had early childhood caries and a comparison group of 123 caries free children attended five kindergartens and pre-schools in Isfahan city. Clinical examinations were conducted to evaluate the caries status. The parents of the two study groups completed the self-administrated long form of the Parenting Stress Index questionnaire. Details of their socio-demographic status were gathered too. The collected data were analyzed by SPSS version 11.5. The nonparametric Mantel-Haenszel test for correlation statistics was used to determine bivariate associations between total parenting stress and their domains scores in the two groups; i.e., those with early childhood caries and the caries free group.
Mean score of PSI in the early childhood caries and caries free group were 286.66 ± 66.26 and 273.87 ± 31.03, respectively. There was not any significant relationship between total parental stress and ECC. The scores of the following domains of PSI demonstrated significant differences between ECC and CF groups: child reinforcement, child distractibility, child deficit attention, life stress and relationship with spouse (P = 0.01, 0.01, 0.001, 0.005 respectively).
Findings of this study did not show any significant association between total parenting stress score and prevalence of early childhood caries.
Dental caries; Dental stress analysis; Oral health
To examine the associations between having a special health care need and school outcomes measured as attendance, student engagement, behavioral threats to achievement, and academic achievement.
PARTICIPANTS AND METHODS:
A total of 1457 children in the fourth through sixth grades from 34 schools in 3 school districts and their parents provided survey data; parents completed the Children With Special Health Care Needs Screener. School records were abstracted for attendance, grades, and standardized achievement test scores.
Across 34 schools, 33% of children screened positive for special health care needs. After adjusting for sociodemographic and school effects, children with special health care needs had lower motivation to do well in school, more disruptive behaviors, and more frequent experiences as a bully victim. They experienced significantly lower academic achievement, as measured by grades, standardized testing, and parental-assessed academic performance. These findings were observed for children who qualified as having a special health care need because they had functional limitations attributed to a chronic illness or a behavioral health problem but not for those who qualified only because they took prescription medications.
Specific subgroups of children with special health care needs are at increased risk for poor school outcomes. Health and school professionals will need to collaborate to identify these children early, intervene with appropriate medical and educational services, and monitor long-term outcomes.
children with special health care needs; student engagement; academic achievement; bullying; school performance; middle childhood; adolescence; school outcomes
(i) to describe oral health counselling in Norway to parents with infants and toddlers, ii) to assess existing collaboration and routines in oral health matters between nurses and personnel in the PDS, iii) to evaluate to what extent oral health was integrated in the basic educational curriculum of public health nurses.
This study was based on two separate surveys: the sample of Study I was 98 randomly selected child health clinics. A questionnaire covering oral health promotion counselling of parents with young children was returned by 259 nurses. Study II was a telephone survey addressing teachers of public health nurses at the eight educational institutions in Norway.
The response rate in Study I was 45%. Nutrition (breast feeding, diet) was the health subject most often prioritized in the counselling targeting parents of young children (by 60% of the nurses). Oral health was not among the first priority counselling subjects. The subject was seldom spontaneously mentioned by parents. Seventy percent of respondents reported (agreed or totally agreed) that they managed to provide information parents needed and 72% believed that the information they gave influenced parents' health behaviours. Seven nurses (5.2%) responded that they agreed with the statement that the information they gave only slightly influenced parents' health behaviour. Lack of time was mentioned as being a problem. Approximately half of the nurses (48%) had regular contact with the PDS for the 0-3 year-old children, but only a quarter of the nurses claimed that children's teeth were routinely examined at the child clinics. Some forms of previously established contact with the PDS enhanced the likelihood of nurses' referrals. Oral health was a minor part of the educational curriculum for public health nurses; at three institutions, the subject was totally absent.
Collaboration between nurses and the PDS in Norway could be improved. Oral health should have a bigger place in the basic educational curriculum.
Involvement of oral health educators among non-health professionals in oral health promotion is important in the prevention of oral diseases. This study was carried out to compare the level of oral health knowledge among pre-school teachers before and after oral health seminar. Pre-test data was collected by distributing questionnaire to pre-school teachers in Pasir Mas, who attended the seminar on “Oral Health” (n=33) and they were required to fill anonymously before the seminar started. The questions consisted of information on general background, perceived oral health status, oral health knowledge and the environment where they work. After two weeks, post-test data was collected using the same structured questionnaire and identification code was used to match the pre and post data. SPSS 11.5 was use for statistical analysis. Two out of 33 eligible preschool teachers were considered non-respondents due to absenteeism during the post-test data collection. The response rate was 94.0% (n = 31). The study shows a significant improvement in oral health knowledge among pre-school teachers in Pasir Mas, after seminar (p < 0.001) as compared to controls. Thus, we can conclude that the oral health programme (seminar) appeared effective at influencing oral health educator’s knowledge towards oral health.
Pre school teachers; oral health educators; oral health promotion
The presence of traumatic dental injuries and malocclusions can have a negative impact on quality of life of young children and their parents, affecting their oral health and well-being. The aim of this study was to assess the impact of traumatic dental injuries and anterior malocclusion traits on the Oral Health-Related Quality of Life (OHRQoL) of children between 2 and 5 years-old.
Parents of 260 children answered the six domains of the Early Childhood Oral Health Impact Scale (ECOHIS) on their perception of the OHRQoL (outcome). Two calibrated dentists assessed the types of traumatic dental injuries (Kappa = 0.9) and the presence of anterior malocclusion traits (Kappa = 1.0). OHRQoL was measured using the ECOHIS. Poisson regression was used to associate the type of traumatic dental injury and the presence of anterior malocclusion traits to the outcome.
The presence of anterior malocclusion traits did not show a negative impact on the overall OHRQoL mean or in each domain. Only complicated traumatic dental injuries showed a negative impact on the symptoms (p = 0.005), psychological (p = 0.029), self image/social interaction (p = 0.004) and family function (p = 0.018) domains and on the overall OHRQoL mean score (p = 0.002). The presence of complicated traumatic dental injuries showed an increased negative impact on the children's quality of life (RR = 1.89; 95% CI = 1.36, 2.63; p < 0.001).
Complicated traumatic dental injuries have a negative impact on the OHRQoL of preschool children and their parents, but anterior malocclusion traits do not.
tooth injuries; malocclusion; oral health-related quality of life; preschool child
Dental caries among young children are a global problem. Scant attention is paid towards primary teeth, leading to high prevalence of dental caries. There are only few studies done in Sri Lanka, addressing oral hygiene among preschool children. Scientific evidence is in need to persuade authorities to establish a programme promoting oral hygiene among preschool children.
A descriptive cross sectional study was conducted in Ragama Medical officer of Health area. Consecutive children between 2 – 5 years of age, attending child welfare clinics were recruited for the study. Practices related to dental hygiene and socio-economic characteristics were obtained using an interviewer administered questionnaire. Mouth was examined for evidence of dental caries. Data collection and examination were done by two doctors who were trained for this purpose. The data were analysed using SSPS version 16.
Total of 410 children were included. None had a routine visits to a dentist. Practices related to tooth brushing were satisfactory. Prevalence of dental caries gradually increased with age to reach 68.8% by 5 years. Mean total decayed-extracted-filled (deft) score for the whole sample was 1.41 and Significant caries index (SIC) was 4.09. Decayed tooth were the main contributor for the deft score and Care index was only 1.55. Girls had a significantly higher prevalence of caries than boys.
Dental care provided for Sri Lankan preschool children appears to be unsatisfactory as prevalence of dental caries among this cohort of preschool children was very high. There is an urgent need to improve dental care facilities for Sri Lankan preschool children.
Dental caries; Deft score; SIC index; Care index
The purpose of this study was to determine the prevalence of the dmft-DMFT indexes and the oral hygiene status of 136 individuals attending a special school for the disabled.
Participants were grouped according to disability [Mental Retardation (MR), Cerebral Palsy (CP), Autistic Disorder (AD), Down Syndrome (DS), Other (OTH)] and age [2–6 years (n=24), 7–12 years (50 children) and 13+ years (62 children]. Caries examinations were carried out in accordance with WHO criteria and oral cleanliness was evaluated by visually assessing the presence of plaque on teeth.
The age range of patients was 2–26 years (mean age: 11.89±5.19 years). Mean dmft and DMFT scores by age group were as follows: 2–6 years: dmft=2.04±2.24; 7–12 years: dmft=2.24±2.60, DMFT=0.98±2.58; 13+years: DMFT=2.68±2.91. Overall, 15.4% of children had no caries or fillings. While dmft and DMFT levels (P>.05) did not vary significantly by type of disability, oral cleanliness did. Children with autism were observed to maintain the best oral hygiene and those with mental retardation (MR), the poorest.
It is important for the dentist to concentrate on a preventive approach and provide proper dental education to parents of disabled individuals. Among the children with disabilities, more attention should be paid to the oral hygiene of MR group.
Disabled individual; Oral health; Caries; Oral plaque
Most of the instruments available to measure the oral health-related quality of life (OHRQoL) in paediatric populations focus on older children, whereas parental reports are used for very young children. The scale of oral health outcomes for 5-year-old children (SOHO-5) assesses the OHRQoL of very young children through self-reports and parental proxy reports. We aimed to cross-culturally adapt the SOHO-5 to the Brazilian Portuguese language and to assess its reliability and validity.
We tested the quality of the cross-cultural adaptation in 2 pilot studies with 40 children aged 5–6 years and their parents. The measurement was tested for reliability and validity on 193 children that attended the paediatric dental screening program at the University of São Paulo. The children were also clinically examined for dental caries. The internal consistency was demonstrated by a Cronbach's alpha coefficient of 0.90 for the children’s self-reports and 0.77 for the parental proxy reports. The test-retest reliability results, which were based on repeated administrations on 159 children, were excellent; the intraclass correlation coefficient was 0.98 for parental and 0.92 for child reports. In general, the construct validity was satisfactory and demonstrated consistent and strong associations between the SOHO-5 and different subjective global ratings of oral health, perceived dental treatment need and overall well-being in both the parental and children’s versions (p < 0.001). The SOHO-5 was also able to clearly discriminate between children with and without a history of dental caries (mean scores: 5.8 and 1.1, respectively; p < 0.001).
The present study demonstrated that the SOHO-5 exhibits satisfactory psychometric properties and is applicable to 5- to 6-year-old children in Brazil.
Oral health; Quality of life; Preschool children; Parents; Validation
To examine tooth loss and dental caries by sociodemographic characteristics from community-based oral health examinations conducted by dentists in northern Manhattan.
The ElderSmile programme of the Columbia University College of Dental Medicine serves older adults with varying functional capacities across settings. This report is focused on relatively mobile, socially engaged participants who live in the impoverished communities of Harlem and Washington Heights/Inwood in northern Manhattan, New York City.
Materials and Methods
Self-reported sociodemographic characteristics and health and health care information were provided by community-dwelling ElderSmile participants aged 65 years and older who took part in community-based oral health education and completed a screening questionnaire. Oral health examinations were conducted by trained dentists in partnering prevention centres among ElderSmile participants who agreed to be clinically screened (90.8%).
The dental caries experience of ElderSmile participants varied significantly by sociodemographic predictors and smoking history. After adjustment in a multivariable logistic regression model, older age, non-Hispanic Black and Hispanic race/ethnicity, and a history of current or former smoking were important predictors of edentulism.
Provision of oral health screenings in community-based settings may result in opportunities to intervene before oral disease is severe, leading to improved oral health for older adults.
elderly; oral health; dental caries; tooth loss; ageing; geriatric dentistry
Aesthetic alterations in the face can be self-perceived and can affect quality of life. For young people, physical attractiveness is an important factor affecting social relationships. The aim of this study was to estimate the prevalence of malocclusion, identify the most common types and test its association with oral aesthetic self-perception in 18 to 21 year-old population of male young adults.
A cross-sectional study was carried out involving 138 Brazilian Army soldiers. Data collection included socio demographic profile, malocclusion status through the Dental Aesthetic Index (DAI) and oral aesthetic self-perception as indicated by the Oral Aesthetic Subjective Impact Scale (OASIS). The chi-square and Fisher’s exact test were used to test for homogeneity of proportions. The stepwise multivariate logistic regression analysis was used to test for the relationship between the poorer oral aesthetic self-perception and parental and soldier’s education, per capita income, history of caries in all teeth and only on anterior teeth, dental trauma, previous orthodontic treatment and malocclusion.
The prevalence of malocclusion was 45.6%. Incisor teeth crowding and misalignment of lower incisors were the most common types of malocclusions. A statistically significant and independent association between malocclusion and poorer oral aesthetic self-perception in the multivariate analysis was observed. Subjects with severe malocclusion conditions showed 88% higher prevalence [prevalence ratio =1.88 (95% CI, 1.30 – 2.72); p = 0.001] of poorer aesthetic self-perception comparing to those with minor malocclusion.
A high prevalence of malocclusion was observed. The young adults presenting severe malocclusion had a higher and independent prevalence of poorer oral aesthetic self-perception.
Malocclusion; Oral health; Aesthetics; Quality of life
Rationale: oral health is one of the fundamental steps to general health, well being and a determinant factor for the quality of life.
Objective of this cross–sectional study is to assess the oral–systemic health and the treatment needs among the institutionalized people in a homeless center, with high prevalence of co–morbidities and barriers to care.
Methods and Results: after getting the informed consent, 51 adults from a community, which is disadvantaged from a socio–economic and medical point of view, were studied: frequently with multiple general diseases treated with medicines that produce oral side effects, a high need of treatment and the lack of a dental office. The subjects were orally examined from a clinical point of view and received a questionnaire with regard to the presence of the health risk factors. General health status and drug treatments of subjects were evaluated based on medical records. Results showed that oral health status of the subjects is precarious, oral hygiene is poor and the subjects are exposed to common risk factors for oral and systemic diseases: tobacco use, alcohol consumption, diet, poor hygiene and history of cancer.
Discussion: if their needs are not met, the oral health will be persistently poor and will further deteriorate during their residency, because of increasing care dependency and subsequent lack of adequate oral health care. Despite great achievements in oral and general health of populations, problems still remain in many communities, particularly among underprivileged groups.
institutionalized people; chronic diseases; risk factors; medications; treatment needs
The oral health being an integral part for the healthy living, necessity of disability limitation and rehabilitation in oral health has taken a paramount role. To assess the prosthetic status and to evaluate the prosthetic needs of the patients attending various institutes of Ahmedabad and Gandhinagar district. A total of 510 (264 males and 246 females) subjects at various dental institutes were examined in the study. A survey proforma was prepared with the help of WHO oral health assessment form (1997). Prosthetic status and prosthetic treatment need was recorded. Out of 510, any type of Edentulousness was 322 (63 %). Among them, 254 (49.8 %) were partially edentulous while 68 (13.3 %) were completely edentulous. Only 69 (13 %) were having any prosthesis in upper arch while only 80 (16 %) were having any prosthesis in lower arch. Need for any type of prosthesis in upper and lower arch was 55 and 60 % in males and females, respectively. In lower social class group need of prosthesis in upper and lower arch was 62 and 63 %, respectively. It was found that prosthetic status and prosthetic treatment need increased with increase in age. Steps should be taken to overcome this disparity and more emphasis should be given to meet the felt need of the people through government and non government organizations to improve the oral health. The unmet prosthetic treatment need should be met to rehabilitate needy people so that their disability may be limited.
Prosthetic status; Prosthetic treatment need; Socioeconomic group
Despite wide recognition that children with disability often have poor oral health, few high quality, controlled results are available.
Twenty-four objective and subjective criteria covering feeding, autonomy, access to dental care, oral hygiene, oral disease, general health and behavior were evaluated in a observational cross-sectional study of 2,487 children with disability (DC group), 4,772 adolescents with disability (DA group) and 1,641 children without disability (NDC group). Five algorithms ranked the subjects according to clinical criteria in three original oral health indices: the Clinical Oral Health Index (COHI), indicating the level of oral health problems, the Clinical Oral Care Needs Index (COCNI) giving dental care need levels, and the Clinical Oral Prevention Index (COPI) determining possible needs in terms of dental education initiatives.
DC-group children presented poorer oral health and had greater needs in both treatment and preventive oral health actions than NDC-group children (OR = 3.97, 95% CI = 3.25–4.86 for COHI; OR = 2.01, 95% CI = 1.77–2.28 for COCNI; OR = 5.25, 95% CI = 4.55–6.02 for COPI). These conditions were worse again in the DA group comparing to the DC group (OR = 3.52, 95% CI = 2.7–4.6 for COHI; OR = 1.52, 95% CI = 1.38–1.69 for COCNI; OR = 1.53, 95% CI = 1.39–1.69 for COPI).
Clinical indices generated by algorithmic association of various clinical indicators allow sensitive clinical measurement, and in this study demonstrated inequalities in oral health for children with disabilities schooling in institutions. Questions need now to be addressed as to the measures that could be taken to compensate for this situation.
To determine the perceived oral health status and treatment needs of Nigerian dental therapists in training and dental technology students.
A descriptive cross-sectional study of students from Federal School of Dental Therapy and Technology Enugu, Nigeria was conducted using self-administered questionnaire to obtain information on demography, self-reported oral health status, knowledge of impact of oral health on daily life activity, dental attendance and perceived dental need.
The perception of oral health status and treatment need of the two groups of dental auxiliaries was the same. Fewer respondents (27.3%) rated their oral health as excellent, while 50.4% rated their oral health as good. Majority (95.5%) agreed that oral health is a part of general health and 94.6% agreed that oral health has a role in daily life.
Out of 81.4% that had previous dental treatment, scaling and polishing accounted for 66.1%. Presently, 48.8% think they need dental treatment ranging from scaling and polishing (33.9%), tooth restoration (10.3%), to extraction (1.2%).
This survey revealed that most of the students are aware that oral health is a component of general health and that it has an impact on an individual's daily life. More than half of the students perceived their oral health as good, but only a few knew that there is a need for a preventive approach to oral health as evident by the percentage that perceived scaling and polishing as a treatment need.
oral health; status; dental auxiliaries
The objectives for this study were to assess Oral Health Related Quality of Life (OHRQoL) in young people aged 15–25 who sought orthodontic treatment, and to measure the association between orthodontic treatment need (using the IOTN), sex, age and education level, and oral health related quality of life (OHRQoL).
Survey of a consecutive series of 323 young adults aged 15 to 25 years, attending orthodontic clinics at the Faculty of Dentistry, Universiti Teknologi MARA. Participants completed the Oral Health Impact Profile-14 (OHIP-14) and had a clinical examination including the Index of Orthodontic Treatment Need- Dental Health Component (IOTN-DHC). Data analyses included descriptive statistics, One-way ANOVA and bivariate and multivariate regression models.
The mean overall score (± SD) for OHIP-14 in young people aged 15–25 was 22.6 ± 12.5. The psychological discomfort domain was the domain where highest impact was recorded with a mean (± SD) of 4.0 ± 1.9. The regression analyses showed a significant association of IOTN-DHC with overall OHIP-14 score (p < 0.05). Although females reported a slightly higher impact than males, this was not significant in both bivariate and multivariate analyses. Age group had a significant negative association with overall OHIP-14 score (p < 0.05). The 15–18 year old group showed the highest impact on their quality of life due to malocclusion. Participants with a university education report a significantly higher impact on OHRQoL as compared to participants with only secondary education.
Malocclusion has a significant negative impact on OHRQoL and its domains. This is greatest for the psychological discomfort domain. Younger people and those with a university education report higher levels of impact. There was no reported difference in impact between male and females.
Oral health related quality of life; Malocclusion; Treatment need; OHIP
There are only few studies considering the impact of oral mucosal lesions (OML) on the oral quality of life of patients with different dermatological conditions. This study aimed to assess the relationship between oral health-related quality of life (OHRQoL) and OML and reported oral symptoms, perceived general and oral health condition and caries experience in adult skin diseased patients attending an outpatient dermatologic clinic in Sudan.
A cross-sectional survey was carried out with 544 diagnosed skin diseased patients (mean age 37.1 years, 50 % females), during the period October 2008 to January 2009. The patients were orally examined and OML and caries experience was recorded. The patients were interviewed using the Sudanese Arabic version of the OIDP. OHRQoL was evaluated by socio-demographic and clinical correlates according to number of types of OML diagnosed (no OML, one type of OML, > one type of OML) and number and types of oral symptoms.
An oral impact (OIDP > 0) was reported by 190 patients (35.6 %) (mean OIDP total score 11.6, sd = 6.7). The prevalence of any oral impact was 30.5 %, 36.7 % and 44.1 %, in patients with no OML, one type of OML and more than one type of OML, respectively. Number of types of OML and number and types of oral symptoms were consistently associated with the OIDP scores. Patients who reported bad oral health, patients with ≥ 1 dental attendance, patients with > 1 type of OML, and patients with ≥ 1 type of oral symptoms were more likely than their counterparts in the opposite groups to report any OIDP. The odds ratios (OR) were respectively; 2.9 (95 % CI 1.9-4.5), 2.3 (95 % CI 1.5-3.5), 1.8 (95 % CI 1.1-3.2) and 6.7 (95 % CI 2.6-17.5). Vesiculobullous and ulcerative lesions of OML disease groups associated statistically significantly with OIDP.
OIDP was more frequently affected among skin diseased patients with than without OML. The frequency of the impacts differed according to the number of type of OML, oral symptoms, and OML disease groups. Dentists and dermatologists should pay special attention to skin diseased patients because they are likely to experience oral impacts on daily performances.
dermatology; oral mucosal lesions; oral impact on daily performance; quality of life
In Finland, dental services are provided by a public (PDS) and a private sector. In the past, children, young adults and special needs groups were entitled to care and treatment from the public dental services (PDS). A major reform in 2001 – 2002 opened the PDS and extended subsidies for private dental services to all adults. It aimed to increase equity by improving adults' access to oral health care and reducing cost barriers. The aim of this study was to assess the impacts of the reform on the utilization of publicly funded and private dental services, numbers and distribution of personnel and costs in 2000 and in 2004, before and after the oral health care reform. An evaluation was made of how the health political goals of the reform: integrating oral health care into general health care, improving adults' access to care and lowering cost barriers had been fulfilled during the study period.
National registers were used as data sources for the study. Use of dental services, personnel resources and costs in 2000 (before the reform) and in 2004 (after the reform) were compared.
In 2000, when access to publicly subsidised dental services was restricted to those born in 1956 or later, every third adult used the PDS or subsidised private services. By 2004, when subsidies had been extended to the whole adult population, this increased to almost every second adult. The PDS reported having seen 118 076 more adult patients in 2004 than in 2000. The private sector had the same number of patients but 542 656 of them had not previously been entitled to partial reimbursement of fees.
The use of both public and subsidised private services increased most in big cities and urban municipalities where access to the PDS had been poor and the number of private practitioners was high. The PDS employed more dentists (6.5%) and the number of private practitioners fell by 6.9%. The total dental care expenditure (PDS plus private) increased by 21% during the study period. Private patients who had previously not been entitled to reimbursements seemed to gain most from the reform.
The results of this study indicate that implementation of a substantial reform, that changes the traditionally defined tasks of the public and private sectors in an established oral health care provision system, proceeds slowly, is expensive and probably requires more stringent steering than was the case in Finland 2001 – 2004. However, the equity and fairness of the oral health care provision system improved and access to services and cost-sharing improved slightly.
Intestinal parasitic infections are widely distributed throughout the world and children are the most affected population. Day care centres are environments where children have proven to be more susceptible to acquiring IP.
Methods and Principal Findings
A cross-sectional study was carried to determine the prevalence of intestinal parasites in stool samples among children who attend to a day care centre in an urban area of Matanzas city, Cuba, from March to June 2012. 104 children under five years old were included on the study after informed consent form was signed by parents or legal guardians. Three fresh faecal samples were collected from each child in different days and were examined by direct wet mount, formalin-ether, and Kato- Katz techniques. Data relating to demography, socioeconomic status, source of drinking water, and personal hygiene habits were also collected using a standardized questionnaire. In total, 71.1% of children harbored at least one type of intestinal parasite and 47 (45.2%) were infected by more than one species. Giardia duodenalis and Blastocystis sp. were the most common parasites found, with prevalence rates of 54.8% and 38.5% respectively.
Despite public health campaigns, improvement in the level of education, and the availability of and access to medical services in Cuba infections by intestinal protozoan is high in this centre. Almost nothing is published regarding intestinal parasites in Matanzas province during the last 40 years so this work could also be the initial point to carry out other studies to clarify the IP status in this region.
To estimate the prevalence of nasopharyngeal (NP) carriage of pneumococcus (Streptococcus pneumoniae) and describe the antibiotic resistance patterns and serotypes in young children attending group day care in London.
Design and subjects
Cross‐sectional survey of attendees at a sample of registered child day care centres (CDCCs) in a London borough.
Urban setting with a socially and culturally diverse population.
Methods and outcomes
19 CDCCs (13% of total) participated between March and November 2003. A single NP swab was required from each child, and parents completed a questionnaire about their child's health and attendance at day care. WHO methodology for pneumococcal carriage studies was followed.
30% of parents consented. 234 swabs were collected from children aged 6 months to 5 years. 53% were boys and 81% were white. 120 children (51%, 95% CI 45% to 58%) carried pneumococci in their nasopharynx. None of the isolates were resistant to penicillin (upper CL 3%). 21 isolates were resistant to erythromycin (17.5%, 95% CI 11% to 25.5%). 68 isolates (57%) were serotypes included in the 7‐valent conjugate vaccine. Non‐white children had a lower prevalence of carriage (27% vs 58%).
Conclusion: The prevalence of pneumococcal NP carriage was high. The penicillin resistance rate is lower than in many other countries and may reflect a decrease in community antibiotic prescribing in the UK. Monitoring circulating serotypes is important in the context of recent changes to the vaccination policy. Further study is required to explore the association with ethnicity and risk factors for antibiotic resistance.
A preliminary investigation of a method of providing health screening in day care centers was conducted. Ninety-four children, birth to 6 years, attending two day care centers were screened for health and developmental problems. A nurse trained day care staff to conduct the screenings, supervised their activities, rescreened children with questionable results, and conducted an interrater reliability study as well as referral and followup activities. The nurse also did assessments of environmental characteristics of the programs, their policies, procedures, and activities and assessed staff and parent information needs concerning child development, health practices, and health needs of children. Thirty-nine problems were identified in 33 children. Followups of 29 problems were completed, and 16 of these were verified. The 29 problems resulted in a total of 35 visits to primary health care providers. Among parents of children with verified problems, only three had been aware of the problem. The overreferral rate was 47 percent. Interrater percentages of agreement on most screenings were more than 80 percent. The findings suggested that the screenings were feasible with specific modifications. The screening activities were acceptable to parents, their physicians, and center staff. Centers were responsive to staff and parent needs identified in the screening process but not to recommendations for change within the environment and in operating procedures, partly because of fiscal implications. Screenings were adequate to identify a number of health problems prevalent in children under 6, and interrater reliabilities were acceptable.
Background and aims
Children and adolescents with disabilities appear to have poorer oral health than their non-disabled counterparts. The aim of this study was to assess the frequency and severity of oral diseases and treatment needs using world health organization criteria of caries, periodontal disease and malocclusions in a selected population of children with disabilities in Mashhad, Iran.
Materials and methods
A randomized study on 1621 children aged 5-16 was conducted in 13 special schools by six examiners, using a mouth mirror, explorer and enough lighting.
The caries frequency of hearing impaired children (HI) was lower than those mentally retarded (MR) and visually impaired (VI) (DMFT: 2 ± 1.91 versus 2.27± 1.97 and 2.68 ± 2.30, respectively). MR children appear to have poorer oral hygiene and periodontal status than their otherwise disabled counterparts. Most children had class I malocclusion (57%).
According to this study, an epidemiological survey followed by the implementation and evaluation of long-term public dental health care plan for children and adolescents with disabilities is highly recommended.
Dental caries; disabled children; DMFT index; epidemiology; periodontal diseases
According to World Oral Health report 2003, the prevalence of periodontitis is 86% in India. Dental care can sometimes be a forgotten part of a healthy life style. While its importance is often underestimated, the need for regular dental care cannot be overstated. Oral health has been neglected for long in India. The scarce literature on dental health awareness, attitude, oral health-related habits and behavior among the adult population in Rajasthan prompted us to assess the preventive oral health awareness and oral hygiene practices in patients attending outpatient department of Vyas Dental College and Hospital (VDCH), Jodhpur through this study.
Materials and Methods:
A total of 500 patients in the age group 15–50 years were selected using random sampling technique. A self-administered structured questionnaire including 16 multiple choice questions was given to them. The results were analyzed using percentage.
The result of this study shows an acute lack of oral hygiene awareness and limited knowledge of oral hygiene practices. In Jodhpur, few people use tooth brush.
Hence, there is an urgent need for comprehensive educational programs to promote good oral health and impart education about correct oral hygiene practices.
Motivation; oral hygiene practices; oral hygiene awareness
In Turkey, formal pre-primary education for children 5- 6 years old provides the ideal setting for school-based oral health promotion programs and oral health care services. To develop effective oral health promotion programs, there is a need to assess this target group's subjective oral health needs as well as clinical needs. The Early Childhood Oral Health Impact Scale (ECOHIS) is a well-known instrument for assessing oral health quality of life in children aged 0-5 years old and their families. This study aimed to adapt the ECOHIS for children 5-6 years old in a Turkish-speaking community and to undertake a preliminary investigation of its psychometric properties.
The Turkish version of the ECOHIS was obtained with forward/backward translations, expert panels and pre-testing and it was tested in a convenience sample of 121 parents of 5- 6 year-old children attending nursery classes of three public schools. Data were collected through clinical examinations and self-completed questionnaires. The main analyses were carried out on the imputed data set. The validity of content, face, construct, discriminant and convergent and as well as the reliability of internal and test-retest of the ECOHIS were evaluated. Sensitivity analysis was performed to examine the effect of the complete case analysis for managing "Don't know" responses on the validity and reliability of the ECOHIS.
The analysis of the imputed data set showed that Cronbach's alphas for the child and family sections were 0.92 and 0.84 respectively, and for the whole scale was 0.93. The intraclass correlation coefficient for test-retest was 0.86. The scale scores on the child and parent sections indicating worse quality of life were significantly associated with poor parental ratings of their child's oral health, high caries experience, higher gingival index scores and problem-orientated dental attendance, supporting its construct, convergent and discriminant validity. Sensitivity analysis showed that the mean imputation method and the complete case analysis did not have differing effects on the validity and reliability of the ECOHIS.
This study provided preliminary evidence concerning validity and reliability of the Turkish version of the scale among 5-6-year-old children. Future studies should be conducted on the ECOHIS to evaluate fully its psychometric properties in both community- based and clinically-based studies among parents of children younger than five. This study provides initial evidence that the ECOHIS aimed at children aged 0-5 years may be a useful tool for assessing the oral health quality of life in 6 year - old preschool children.
Quality of life; oral health; reliability and validity; child; preschool.