Access to dental care is the leading unmet health need among American children. Early access to oral health care is critical in the prevention and treatment of early childhood caries, and any barriers perceived by parents can cause delay in seeking treatment. The purpose of this study was to examine child, family, and community factors associated with the utilization of oral health services among U.S. and HRSA region IV children aged 1-5 years. The data were obtained from the 2011/2012 National Survey of Children’s Health. Descriptive statistical summaries were calculated for all independent variables grouped by child, family, and community. A caregiver was asked whether the child received dental care in the past 12 months. Multiple logistic regression analysis using an investigator driven stepwise selection methodology was conducted. Nearly half (46.7%) of caregivers in the national sample reported that their child had visited a dentist in the past 12 months, slightly fewer (46.0%; p

Orientador: João Carlos da Rocha / Coorientador: Fellippo Ramos Verri / Coorientador : Estevão Tomomitsu Kimpara / Banca: Symone Cristina Teixeira / Banca: Carolina Judica Ramos / Resumo: O uso de tecnologias digitais interativas está altamente inserido na sociedade contemporânea e pode ser de grande valia para educação em saúde e melhoria do relacionamento do profissional com paciente e seu responsável/cuidador. O objetivo deste estudo foi desenvolver um aplicativo com funcionalidades tanto para o profissional quanto para o responsável/cuidador do paciente, onde será realizado o preenchimento do diário alimentar e realizada a avaliação do risco de cárie. Para isso, o projeto foi divido em etapas: pesquisa na literatura para a determinação de um método de avaliação do risco de cárie, desenvolvimento do aplicativo e avaliação do mesmo por dentistas especialistas ou com atuação em odontopediatria. O aplicativo desenvolvido, através de design participativo, denominado CarieHelp, mostrou-se eficiente em suas funcionalidades, tendo sido bem avaliado pelos profissionais que o testaram, onde 100% dos voluntários participantes consideraram a linguagem clara e objetiva e afirmaram acreditar que o aplicativo pode influenciar na percepção dos responsáveis quanto a prevenção da doença cárie e 66,7% consideraram o aplicativo altamente útil. Futuramente aperfeiçoamentos podem ser realizados com a intenção inserir de outras funcionalidades que reflitam em ações de educação em saúde / Abstract : The use of interactive digital technologies is highly inserted in contemporary society and can be of great value for health education and improving the relationship of the professional with the patient and their caregiver. The aim of this study was to develop an application with functionalities for both the professional and the patient's parents / caregiver, where the food diary will be filled and the caries risk assessment will be performed. For this, the project was divided into stages: research in the literature to determine a method of caries risk assessment, application development and evaluation by dentists specializing in or acting in pediatric dentistry. The application developed through participatory design, called CarieHelp, proved to be efficient in its functionalities, having been well evaluated by the professionals who tested it, where 100% of the participating volunteers considered the language clear and objective and said they believed the application could influence in the perception of those responsible for the prevention of caries disease and 66.7% considered the application highly useful. Future improvements can be made with the intention of inserting other functionalities that reflect in health education actions / Mestre

Access to oral health care remains problematic for millions of Americans. Factors such as socioeconomic status, age, race, and lack of dental insurance benefits inhibit the ability of many to obtain preventative oral health care. The aim of this study was to explore the effect of preventive oral health treatment and education at reduced-fee dental hygiene facilities on the oral health behaviors and perceptions of socioeconomically deprived persons within the state of Georgia. This study was based on the health belief model constructs. A convenience sample of 102 participants was recruited from the individuals who visited two dental hygiene colleges to seek treatment for the first time. The independent variable was the receipt of reduced-fee dental hygiene treatment/education. The dependent variables were the oral health perceptions and behaviors of socioeconomically deprived persons, as well as the perceptions and behaviors of patients provided with a referral for follow-up treatment with a dentist. Mediating variables were sex, age, race, and socioeconomic status. Wilcoxon Signed Rank test and logistic regression were applied to detect potential differences in the dependent variables before and after treatment. The most significant changes were found in categories dealing with self-efficacy measures that patients could take to improve their own oral health. Also, the oral health behaviors and perceptions of younger, African-American of low educational and financial background were significantly more improved after treatment. The social change implication of this research may be that oral health practitioners can use these results to create preventative interventions more tailored for socioeconomically deprived persons who face complicated oral health issues.

Many people in the United States have untreated dental disease due to a lack of dental insurance, a lack of oral health knowledge, and a lack of priority placed on dental health. Despite an increase in dental service use by Medicaid recipients as a result of local programs, children enrolled in Medicaid often have low rates of use of dental services. Using the health literacy framework of the Paasche-Orlow and Wolf (POW) model, the purpose of this study was to explore to the relationship between oral health literacy of parents and dental service use for children enrolled in Medicaid and the differences in use rates between preventive and restorative services. A cross-sectional research design was employed within a convenience sample of parents who presented to a nonprofit clinic for a medical appointment. Participants completed a demographic profile, an oral health questionnaire, and REALD-30 survey. Responses were correlated with dental claims retrieved from 1 reference child for each parent. Pearson's correlation revealed no significant relationship between oral health literacy and dental service utilization, r = -.056 (p = .490). An ANOVA revealed no difference in utilization between preventive and restorative services, F (2, 149) = .173, p = .841, ç2 = .002. However, high rates of use for restorative services were observed, suggesting a high prevalence of tooth decay in children. Although this study did not find a significant relationship between oral health literacy and dental utilization, barriers continue to exist that contribute to the high rates of tooth decay in children enrolled in Medicaid. This study impacted social change by highlighting the importance of preventive care in reducing the prevalence of tooth decay.

Oral health impacts general health and well-being throughout the lifespan. Recent trends in the United States towards cessation of community water fluoridation (CWF) may increase disparities in oral health. The purpose of this quantitative retrospective cohort study was to analyze Medicaid dental claims records for caries related procedures among 0 to18-year-old patients during an optimal CWF year 2003 (n = 854) and compare them to claims records from 2012 (n = 1,053), 5 years after CWF was ceased. The theoretical framework of this study was the diffusion of innovations theory. Statistically significant results included higher mean number of caries related procedures among 0 to18 year and < 7-year aged patients in the suboptimal CWF group (2.57 vs. 2.43, p < 0.001; 2.68 vs. 2.01, p = 0.004, respectively). Mean caries related treatment costs per patient was also higher in the 0 to18 year and < 7-year suboptimal CWF groups compared to the optimal CWF group (583.70 vs 344.34 $, p < 0.0001; 692.87 vs. 350.13 $, p < 0.0001, respectively). Binary logistic regression analysis results indicated a protective effect from optimal CWF for the 0 to18 and < 7 year age groups ([OR] 0.75, 95% CI [0.62, 0.90], p = 0.002); OR = 0.70, 95% CI [0.52, 0.95], p = 0.02, respectively). The results confirm optimal CWF exposure prevents dental decay, expand the evidence base of caries epidemiology under CWF cessation, and indicate patients without early childhood CWF exposure experience more dental caries procedures and treatment costs. These findings may create opportunities for social change by supplying evidence that can be used to improve equity oriented oral health public policies that protect population health.

Objective: To understand the association between dental insurance coverage and dental care utilization in Iowa children. Methods: The 2010 Iowa Child and Family Household Health Survey (IHHS) data was used to assess the association between dental insurance coverage and dental care utilization in Iowa children. Andersen’s model of health services utilization was used as a framework for determining the predictors of dental care utilization. Chi-square test was used for determining bivariate associations and Logistic regression analysis was used to determine factors associated with dental care utilization. Results: The results from the multivariable logistic regression model indicate that children with private dental insurance (p<0.001) and 4-9 years of age (p=0.005) were more likely to have a dental visit. Additionally, respondents who were always able to get dental appointments for their child (p<0.001), had a regular source of dental care for the child (p<0.001) and perceived dental need for their child (p<0.001), were more likely to report having a dental check-up for their child in the past 12 months. Conclusion: Dental insurance was significantly associated with having a dental visit in the past year in Iowa children 4-17 years of age. Some of the other predictors of dental care utilization were: having a regular source of dental care for the child, ease of getting dental appointment for the child, younger child’s age and having perceived dental need for the child.

Background: Oral health is an integral part of the general health and quality of life. Yet oral health among older people requiring nursing care is often poor. Despite this group’s frequent contact with health care services, they tend to lose contact with dental care. In nursing care, nursing staff are tasked to assist with oral hygiene care, but this has become more demanding as many older people retain more teeth or have advanced prosthetic constructions. Previous research in the field emphasised the need of collaboration between dental- and nursing care to support the nursing staff in this task. However, there is a lack of evidence regarding the effects of these collaborations. Aim: The overall aim of the thesis is to examine two oral health programmes used within nursing care with different design regarding support from and collaboration with dental care. Methods: Quantitative research methods was used. The data in Study I comes from an oral health assessments guide (ROAG-J) performed by nursing staff in a national health register. Oral health, assessed at two occasions from older people with nursing care, were used. Study II was a controlled intervention study performed at a nursing home. The intervention involved individual coaching of nursing staff in oral hygiene care by dental hygienist for four hours per week at the ward for a period of three months. Oral assessments of older people were performed by dental hygienists and questionnaires to nursing home staff were used. Result: In Study I, 667 individuals aged 65 years or older, receiving nursing care services and assessed using ROAG-J between November 2011 and March 2014 were included. No statistically significant difference in any of the oral health variables was found between the first and subsequent assessments. At the first assessments, less than one third of participants had oral health problems. At the first assessment, status of the tongue differed in men and women (p &lt; .01); at the subsequent assessment, gender differences were found in voice (p &lt; .05), mucous membranes (p &lt; .003), tongue (p &lt; .01), and saliva (p &lt; .006). In Study II, 33 nursing staff and 48 residents participated at the baseline measurement and 22 and 32 respectively at the 9-month follow-up. The nursing staff changed in knowledge and attitudes related to gum disease, approximal cleaning, usage of fluoride and the likelihood that older persons would express the need for oral health support. The most frequently reported oral health problems among the residents pertained to teeth and gums. The residents relatively high level of oral health was stable during the study period. Conclusions: The participants in the oral health programmes were able to maintain an acceptable level of oral health during the study periods although health was likely to decline. The nursing staff maintained a high level of knowledge and attitudes about oral health. However, there seems to be a discrepancy regarding the prevalence of oral health problems among older people. A collaboration between dental- and nursing care providers indicates a positive influence on providing oral hygiene care.

Adult Oral Health Programme: The Effect of Periodontal Treatment and the Use of a Triclosan Containing Toothpaste on Glycaemic Control in Diabetics Abstract Aim: The aim of the research study is to establish an adult oral health programme for diabetics in Majuro, Republic of the Marshall Islands in order to determine the impact of non-surgical periodontal treatment followed by the use of a triclosan containing dentifrice on the maintenance of periodontal health and glycaemic control in type 2 diabetic patients. Hypothesis: Non-surgical periodontal treatment results in improved periodontal health and better glycaemic control in diabetics and use of a triclosan containing toothpaste is effective in maintaining this improvement in diabetics. Methods: An adult oral health programme was created, within which was conducted a two-group randomised clinical trial to address the hypothesis that non-surgical periodontal treatment results in improved periodontal health and better glycaemic control in type 2 diabetics and that the use of a triclosan containing toothpaste is effective in maintaining this improvement in diabetics. In this double blind controlled trial, sixty adult patients (aged 35 to 65 years) with type 2 diabetes mellitus having a minimum of 16 teeth received non-surgical periodontal treatment. Half of the patients were randomly assigned to use a triclosan containing toothpaste, Colgate Total, and the other group a non-triclosan toothpaste, Colgate Fluoriguard. The study evaluated the improvement in periodontal health by recording Probing Pocket Depth (PPD) on 6 sites of each tooth, and the number of sites bleeding on probing (BOP) at baseline, and at 6 months and 12 months after treatment. The second part of the study evaluated the impact of improvement of periodontal health on glycaemic control in type 2 diabetics by measuring HbA1c and RBS, and also assessing the levels of C-Peptides and CRP at baseline, and at 6 months and 12 months after treatment. The study also evaluated the effectiveness of a triclosan containing toothpaste in maintaining the improvement in periodontal health after non-surgical periodontal treatment. Results: The results showed that it was feasible to establish an oral health programme for the diabetics and could improve their periodontal health, and that toothpaste containing triclosan is effective in maintaining the improved periodontal heath in type 2 diabetics. Mean PPD dropped from 2.35mm to 1.95mm in the triclosan group and from 2.49mm to 2.24 mm in the non-triclosan group and the mean number of BOP sites dropped from 4.9 to 2.8 in the triclosan group and from 4.7 to 3.2 in the fluoriguard at 12 month visits. However, the results did not show improvement of HbA1c nor RBS levels in either group. C-Peptide levels increased and C-Reactive Protein levels decreased in both groups, however, not to significant levels at 12 month visits. Conclusion: The results of this research study lead to the conclusion that treating periodontal infection has effect of periodontal health of type 2 diabetic patients and following-up with simple personal oral hygiene of regular tooth-brushing helps maintain their periodontal health. This programme also proved that this type of oral health programme is feasible and valuable for diabetics in isolated places like the Marshall Islands, where infrastructure, personnel and resources are limited to treat microvascular and macrovascular complications of diabetes. As for the effectiveness of treating periodontal infections on glycaemic control of diabetics, this study failed to support the hypothesis that non-surgical treatment plus triclosan containing toothpaste would lead to better glycaemic management through improved periodontal health.

<p><strong>Syftet</strong> med denna studie var att undersöka upplevelser av munhälsa hos äldre personer som var medlemmar i olika pensionärsföreningar samt jämföra om det fanns skillnader mellan män och kvinnor.</p><p><strong>Material och metod:</strong><em> </em>Studien har utförts som en kvantitativ tvärsnittsundersökning och data har samlats in hos olika pensionärsföreningar i nordöstra Skåne. En enkät lämnades ut till 202 pensionärer som deltog i studien.</p><p><strong>Resultat: </strong>De flesta var nöjda med sina tänder. Kvinnor (68 %) uppgav att de tuggade all sorts mat mycket bra i jämförelse med männen (45 %) (p=0, 006P() var stor skillnad istatis är). Det största problem som förekom hos pensionärerna var muntorrhet.</p><p><strong>Konklusion: </strong>De äldre som deltog i denna studie upplevde sin munhälsa positivt. Bland de problem som förekom var muntorrhet vanligast.</p><p> </p> / <p><strong>Aim:</strong> The aims of this study were to investigate the experiences of oral health in elderly individuals who were members in various pensioners' associations, and to compare if there were differences between men and women.</p><p><strong>Materials and methods</strong><em>: </em>The study was conducted as a quantitative cross-sectional survey in various pensioners' associations in north-eastern Skåne, Sweden. A questionnaire was handed out to 202 pensions who participated in the study.</p><p><strong>Result:</strong> Most of the elderly were satisfied with their teeth. Sixty eight percent of the women indicated that they could chew at all kinds of food very well as compared to 45 % of the men (p = 0. 006). The main oral health problem was dry mouth.</p><p><strong>Conclusion: </strong>The<strong> </strong>elderly that participated in this study perceived their oral health as being good. A frequent complaint that occurred was dry mouth.</p><p> </p>

<p>Kunskaper i oral hälsa har betydelse för att sjuksköterskor på ett tidigt stadium ska kunna upptäcka olika sjukdomstillstånd i munhålan. Bristande kunskap i oral hälsa har rapporterats vara ett problem inom vården och därför behövs det ökad utbildning inom oral hälsa hos sjuksköterskor. Syftet med studien var att jämföra kunskaper inom oral hälsa mellan sjuksköterskestudenter i årskurs 1 och årskurs 3. Undersökningen skedde med användning av en strukturerad enkät som delades ut av studiens författare till sjuksköterskestudenter som gick årskurs 1 (n= 95) och årskurs 3 (n= 57) vid Högskolan Kristianstad. Studenterna ansåg sig ha bra teoretiska och praktiska kunskaper medan det i resultatet av kunskapsfrågorna framkom att det fanns brister. Resultatet visade också att statistiskt signifikanta skillnader fanns i kunskap mellan studenterna i årskurs 1 och årskurs 3 på frågor om svampinfektion, muntorrhet, protes och bedömning av munstatus. I denna studie var kunskaperna låga i flera områden inom oral hälsa hos sjuksköterskestudenterna. Ökad utbildning är önskvärt för att vårdtagare ska få de åtgärder som de är i behov av i munhålan.</p> / <p>Knowledge of oral health is important so registered nurses, at an early stage, can detect various diseases in the oral cavity. Lack of knowledge in oral health has been reported among registered nurses. The purpose of this study was to compare the knowledge in oral health between nursing students in grade 1 and grade 3. The study was based on a questionnaire with fixed response alternatives that were distributed by the author to nursing students in grade 1 and grade 3 at Kristianstad University. The students claimed to have good theoretical and practical knowledge while the survey revealed that there were gaps in knowledge. The results showed also that there was a statistically significant difference in knowledge between students in grade 1 and grade 3 concerning candidiasis, xerostomia, prosthesis and oral health assessments. In this study the knowledge is low in several areas within oral health among the nursing students. Increased education is desirable to ensure adequate oral health procedures among patients in hospital or nursing homes.</p> / nursing students, oral health, knowledge