Dental caries (decay) is an international public health challenge, especially amongst young children. Early Childhood Caries is a rapidly progressing disease leading to severe pain, anxiety, sepsis ...and sleep loss, and is a major health problem particularly for disadvantaged populations. There is currently a lack of research exploring the interactions between risk and protective factors in the development of early childhood caries, in particular the effects of infant feeding practises.
This is an observational cohort study and involves the recruitment of a birth cohort from disadvantaged communities in South Western Sydney. Mothers will be invited to join the study soon after the birth of their child at the time of the first home visit by Child and Family Health Nurses. Data on feeding practices and dental health behaviours will be gathered utilizing a telephone interview at 4, 8 and 12 months, and thereafter at 6 monthly intervals until the child is aged 5 years. Information collected will include a) initiation and duration of breastfeeding, b) introduction of solid food, c) intake of cariogenic and non-cariogenic foods, d) fluoride exposure, and e) oral hygiene practices. Children will have a dental and anthropometric examination at 2 and 5 years of age and the main outcome measures will be oral health quality of life, caries prevalence and caries incidence.
This study will provide evidence of the association of early childhood feeding practices and the oral health of preschool children. In addition, information will be collected on breastfeeding practices and the oral health concerns of mothers living in disadvantaged areas in South Western Sydney.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Qualitative methodologies are increasingly popular in medical research. Grounded theory is the methodology most-often cited by authors of qualitative studies in medicine, but it has been suggested ...that many 'grounded theory' studies are not concordant with the methodology. In this paper we provide a worked example of a grounded theory project. Our aim is to provide a model for practice, to connect medical researchers with a useful methodology, and to increase the quality of 'grounded theory' research published in the medical literature.
We documented a worked example of using grounded theory methodology in practice.
We describe our sampling, data collection, data analysis and interpretation. We explain how these steps were consistent with grounded theory methodology, and show how they related to one another. Grounded theory methodology assisted us to develop a detailed model of the process of adapting preventive protocols into dental practice, and to analyse variation in this process in different dental practices.
By employing grounded theory methodology rigorously, medical researchers can better design and justify their methods, and produce high-quality findings that will be more useful to patients, professionals and the research community.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Early childhood caries is a common chronic childhood disease and maternal oral health is a risk factor. Improving the oral health behaviours of pregnant women/young mothers can positively influence ...the oral health of children and reduce their caries risk. Such preventative strategies have been undertaken by non-dental professionals producing mixed results encompassing various interventions across the perinatal period. However, no comprehensive review of these studies has been undertaken. The aim of this review was to assess the effectiveness of maternal oral health programs undertaken during the antenatal and/or postnatal period by non-dental health professionals to reduce early childhood caries.
A systematic search of five databases was undertaken using key search terms. Studies were included if they (a) involved quantitative study designs with a control; (b) were published in English; (c) reported on interventions delivered by non-dental professionals (d) delivered the intervention to expectant mothers or mothers with young infants up to 24 months; (e) measured outcomes when the child was under 5 years; (f) measured changes in oral health outcomes of children clinically and oral health behaviours of mothers or children. No restrictions were placed on the study quality and setting.
Nine studies met the inclusion criteria and involved interventions delivered by diverse non-dental professionals across the antenatal (n = 1), postnatal (n = 6) and perinatal period (n = 2). Most studies were of low methodological quality (n = 6). The interventions focussed on oral health education (n = 8), dental referrals (n = 3) and oral health assessments (n = 1). Interventions conducted in either the postnatal or antenatal periods showed meaningful improvements in children's clinical and mother's behavioural oral health outcomes. The outcomes appear to be sustained when a suite of interventions were used along with referral reminders. There were mixed results from interventions across the perinatal period.
Non-dental professionals can promote maternal oral health by providing oral health education, risk assessment and referrals. Combining these interventions could provide a sustained improvement in oral health outcomes for children although current evidence is weak. More high-quality studies are needed to confirm these findings and determine whether the antenatal and/or postnatal period is best suited to deliver these interventions.
Objective:
To systematically review evidence for interventions to prevent early childhood caries (ECC) in Indigenous children in high-income countries.
Search strategy:
In November 2016, we searched ...Medline (from 1946), Embase (from 1980), the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed (from 1996) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (from 1982) for randomised and quasi-randomised controlled trials including children aged 0–5 years. Outcomes included the decayed, missing and filled teeth (dmft) index or similar index; the number of children with reported pain or emergency dental visits because of pain; the number of children referred for dental care; plaque scores; the amount of oral debris present; change in parent/carer attitude or knowledge towards baby teeth; reported regular dental visits and adverse outcomes. Two authors independently screened for inclusion and assessed the risk of bias.
Main results:
Four trials reported in five papers with 2,311 participants were included. Interventions were fluoride varnish with counselling/health promotion, chlorhexidine varnish, and motivational interviewing techniques plus oral hygiene materials and a dental examination. Two trials showed fluoride varnish applied biannually over a 2-year period reduced caries prevalence (mean difference MD: –3.00; 95% confidence interval CI: –4.94 to −1.06; MD: –2.47; 95% CI: –2.57 to −2.37). Motivational interviewing with oral hygiene materials and a dental examination can reduce the number of carious lesions in children aged 30 months (d2–4efs > 0 MD: –5.10; 95% CI: –8.74 to −1.46; d3–4efs > 0; MD: –4.40; 95% CI: –7.55 to −1.25).
Conclusion:
Fluoride varnish applied biannually over 2 years is effective at reducing ECC in Indigenous children. Motivational interviewing has some benefit in caries prevention. Further research is required to test other preventive programmes.
To investigate the potential social and behavioural risk factors influencing the oral health of teenagers aged 14 and 15 years living in New South Wales Australia.
Quantitative and qualitative ...methodologies were used in this research project. Data were obtained from both the clinical and questionnaire components of the NSW Teen Dental Survey 2010 and were analysed in SAS 9.2. The analyses allowed for various demographic and behavioural risk factors to be assessed using caries experience, severe caries and DMFT (decayed, missing or filled teeth) counts as the key outcome variables.
Of the 1,256 14– and 15‐year‐olds who had a dental examination, 1,199 (95.5%) provided questionnaire data. The clinical examinations found that 44.4% of teenagers overall had caries experience in at least one tooth, while 10.6% of the sample had experienced severe caries. Severe dental caries was found to be significantly related to a variety of factors, including family income, fluoridation status, tooth brushing behaviour and sugary drink consumption.
The oral health of 14– and 15‐year‐olds in NSW is influenced by social and dietary factors as well as access to fluoridated water supplies. There was also a strong relationship between self‐rated oral health status with DMFT and with caries experience.
The findings of this study will assist policy makers by highlighting the current caries risk factors that should be part of future health promotion programs.
Issue addressed: Australian Aboriginal children are less likely to access preventive oral health services such as fluoride varnish. The regular application of fluoride varnish can prevent dental ...caries. This study aims to determine if a school-based fluoride varnish program can provide Aboriginal children with at least three fluoride varnish applications over 12 months and whether the routine application of fluoride varnish for Aboriginal children in schools is a feasible approach for oral health promotion in Aboriginal communities.
Methods: A school fluoride varnish program was co-designed with Aboriginal communities in Central Northern New South Wales, Australia and implemented in three schools where majority of enrolled children are Aboriginal. Four "fluoride varnish days," 3 months apart, were held at each school over the 12-month study period. On each "fluoride varnish day" an oral health therapist applied fluoride varnish to all children included in the study.
Results: This study took place between January and December 2017. About 153 children were eligible to participate and 131 (86%) were consented into the program by a parent or guardian. A total of 104 children were enrolled for the entire 12-month study period and included in the analysis. Majority of children (65.4%) received at least three fluoride varnish applications, with an average of 70% of students receiving an application of fluoride varnish on each "fluoride varnish day."
Conclusions: School-based fluoride varnish programs, co-designed with local Aboriginal communities, may be a feasible approach to oral health promotion aimed at improving the oral health of Aboriginal children.
Dear Editor Tooth loss is associated with poorer oral health, compromised diet, nutritional deficiencies and reduced oral health related quality of life (OHRQoL)1. The ‘extent’ of the effect of oral ...health on quality of life, the mean number of times a participant ranks one of the 14 items as ‘most or all of the time’, was also significantly reduced at follow-up (3.2 v 0.5, p=0.008). Summary scores for oral health related quality of life outcomes Michelle Irving, Neelam Kumar, Anthony Blinkhorn, Faculty of Dentistry, University of Sydney Folau Talbot, Kylie Gwynne, Poche Centre for Indigenous Health 1 Gerritsen AE, Allen PF, Witter DJ, Bronkhorst EM, Creugers NHJ.
The purpose of this study was to: (1) describe caries prevalence and experience among Aboriginal children; and (2) investigate the disparity in dental caries between Aboriginal and non-Aboriginal ...Australian children. As background, dental caries is a widespread disease within Aboriginal communities and it has a particularly severe impact on children. In recognition of the extent and severity of this disease, its impact on childhood nutrition, socialisation and schooling, the control of dental caries has been identified as a key indicator in the reduction of disadvantage among Aboriginal communities.
Medline was the primary database used in the literature search. Other databases included: PubMed, Web of Science and Google Scholar. Australian National and State departments of health websites were also searched for relevant documents. Articles were included in the review if they reported information on either caries prevalence rates or experience scores or both, for Aboriginal children in Australia. Articles were excluded if the study sample was special needs children, and/or caries statistics were reported only for children over 12 years.
Caries prevalence among 6-year-olds in rural non-fluoridated Western Australia in 1963 was 27%, and in 2004 was 85% among 6-year-olds in rural non-fluoridated Queensland. There was a corresponding increase in caries experience scores in this period from 2.07 in 1963 to 6.37 in 2004. National estimates for 2000-2003 reported a caries prevalence of 72% and caries experience (dmft: decayed, missing and filled primary teeth) of 3.68 for 6-year-old Aboriginal Australian children. For 12-year-olds the national estimates were a caries prevalence of 45% and experience (DMFT, Decayed, Missing and Filled Permanent Teeth) of 1.25 (SE=0.07). The magnitude of disparity (relative difference) in 6-year-old caries experience between Aboriginal and non-Aboriginal children was relatively consistent over the period 1983-2007, with Aboriginal children having an approximately two-fold higher caries experience score. The 2000-2003 national estimates for caries experience showed that Aboriginal 6-year-olds had a dmft score that was 2.38 times higher than non-Aboriginal children (3.68 vs 1.54). For the 12-year-olds, the magnitude of disparity was not as marked, though the direction was similar.
Both caries prevalence and experience are higher in the primary dentition. In rural Queensland and the Northern Territory there are high caries rates for both 6- and 12-year-olds. Rural Aboriginal children are generally at a disadvantage compared with their urban counterparts. The magnitude of disparity in caries rates appears to be relatively unchanged over time but there is indication that it may be increasing. This raises the issue of health inequity and the need to fund practical, culturally appropriate and sustainable preventive programs. It also indicates the urgent need for more research on the determinants of oral health inequalities.
Early Childhood Caries (ECC) is a widespread problem in Australian Aboriginal communities causing severe pain and sepsis. In addition dental services are difficult to access for many Aboriginal ...children and trying to obtain care can be stressful for the parents. The control of dental caries has been identified as a key indictor in the reduction of Indigenous disadvantage. Thus, there is a need for new approaches to prevent ECC, which reflect the cultural norms of Aboriginal communities.
This is a Phase II single arm trial designed to gather information on the effectiveness of a dental health education program for Aboriginal children aged 6 months, followed over 2 years. The program will deliver advice from Aboriginal Health Workers on tooth brushing, diet and the use of fluoride toothpaste to Aboriginal families. Six waves of data collection will be conducted to enable estimates of change in parental knowledge and their views on the acceptability of the program. The Aboriginal Health Workers will also be interviewed to record their views on the acceptability and program feasibility. Clinical data on the child participants will be recorded when they are 30 months old and compared with a reference population of similar children when the study began. Latent variable modeling will be used to interpret the intervention effects on disease outcome.
The research project will identify barriers to the implementation of a family centered Aboriginal oral health strategy, as well as the development of evidence to assist in the planning of a Phase III cluster randomized study.
ACTRN12612000712808.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
ObjectivesTo critically evaluate the cost-effectiveness of the Midwifery Initiated Oral Health-Dental Service (MIOH-DS) designed to improve oral health of pregnant Australian women. Previous efficacy ...and process evaluations of MIOH-DS showed positive outcomes and improvements across various measures.Design and settingThe evaluation used a cost-utility model based on the initial study design of the MIOH-DS trial in Sydney, Australia from the perspective of public healthcare provider for a duration of 3 months to 4 years.ParticipantsData were sourced from pregnant women (n=638), midwives (n=17) and dentists (n=3) involved in the MIOH trial and long-term follow-up.Cost measuresData included in analysis were the cost of the time required by midwives and dentists to deliver the intervention and the cost of dental treatment provided. Costs were measured using data on utilisation and unit price of intervention components and obtained from a micro-costing approach.Outcome measuresUtility was measured as the number of Disability Adjusted Life Years (DALYs) from health-benefit components of the intervention. Three cost-effectiveness analyses were undertaken using different comparators, thresholds and time scenarios.ResultsCompared with current practice, midwives only intervention meets the Australian threshold (A$50 000) of being cost-effective. The midwives and accessible/affordable dentists joint intervention was only ‘cost-effective’ in 6 months or beyond scenarios. When the midwife only intervention is the comparator, the midwife/dentist programme was ‘cost-effective’ in all scenarios except at 3 months scenario.ConclusionsThe midwives’ only intervention providing oral health education, assessment and referral to existing dental services was cost-effective, and represents a low cost intervention. Midwives’ and dentists’ combined interventions were cost-effective when the benefits were considered over longer periods. The findings highlight short and long term economic benefits of the programme and support the need for policymakers to consider adding an oral health component into antenatal care Australia wide.Trial registration numberACTRN12612001271897; Post-results.
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