Standardizing the job description of public health dentists in South Korea / 대한구강보건학회지

Objectives@#This study addressed longstanding issues in Korea’s public health dentist system by defining and standardizing job duties. A practical job description was drafted based on job analysis results to promote work efficiency and lay the groundwork for future educational programs. @*Methods@#The job description elements were selected and drafted based on previous studies.These drafts were revised and refined with expert panel validation. @*Results@#The main job duties of public health dentists encompass community oral health, dental practice, public oral health research, and special oral health, tailored for institutions such as health sub-centers, health centers, health clinics, national health organizations, and correctional facilities. For community oral health at public health subcenters involves 12 key duties including projects, education, and community engagement. Public health centers/clinics focus on 16 key duties mainly around health project planning and evaluation. Dental care across both settings has 15 main duties. Public oral health research emphasizes community surveys and epidemiology. Special oral health in correctional facilities covers 11 main duties including education and external resource linking. @*Conclusions@#It concluded that for the development of public health dentists in South Korea, it is necessary to develop public health dentist education programs to promote the performance of public health dentists and to equip them with the competencies necessary to perform such duties, focusing on job descriptions organized around the characteristics of workplaces and major tasks.

A Study on the Number of Brushing Strokes in Toothbrushing Education / 치위생과학회지

The purpose of this study was to focus on the number of brushing strokes among the performance factors and identify if the 10 times stroke of the rolling method is rational. Moreover, we evaluated the changes in oral health knowledge, perception, and behavior after our rolling method instruction. The 10-stroke method of toothbrushing has been regarded as an effective method of removal of dental plaque, although there is little evidence to support this claim. We allocated 40 healthy subjects to two intervention groups. During five visits, we measured a score for dental plaque removal and instructed the subjects on a toothbrushing technique with 5 or 10 strokes per section. At the initial and final visits, subjects completed a questionnaire on one designed specifically for this study about oral health knowledge, perceptions, and behaviors. Repeated measures analysis of variance was used to compare the dental plaque removal score between the groups, and the changes in scores within each group over time. We also compared changes in mean scores in oral health knowledge, perceptions and behaviors before and after toothbrushing instruction. We found that the score for dental plaque removal increased with each additional toothbrushing instruction in both groups (p < 0.001). However, we found no differences in the dental plaque removal scores between the 5-stroke and 10-stroke groups (p=0.399). The levels of oral health knowledge, perceptions and behaviors increased after the toothbrushing instructions in both groups. Our findings suggest that there is no advantage in emphasizing the 10-stroke method of toothbrushing in an oral health education program.

Qualitative Research on Communication Education of Dental Hygienist by Focus Group Interview / 치위생과학회지

The purpose of this study to review clinicians and educators on required communication education factors of dental hygienists using qualitative research by focus group interview. The participants were dentists, dental hygienists and professors. A questionnaire was developed on communication education to collect data. The collated data derived concepts related to communication education. After transferring the data, were analyzed by open coding and axial coding using computer-aided qualitative data analysis software. Focus group emphasized that higher education on communication should be preceded before they are put into the clinical field. However, the dental hygienist emphasized experiential education in the clinical field, the professor emphasized additional education for continuity of communication education even after graduation. Besides, focus group emphasized role play, and the professor required that the standardization of the dental communication training courses objectives and role play modules and the education environment infrastructure should be established to implement communication education efficiently. The categories of communication education stated in the focus group were time and method for the dental communication training courses, dental communication training courses standardization and educational environment, of evaluation of communication competency, of perception of the dental communication training courses. This study identified the communication education development to conform with the needs of the clinical field strengthen and cultivate communication competency dental hygienists based on factors of communication education emphasized in focus groups.

The relationship between pit and fissure sealant (PFS) experience and the socio-economic factors of adolescents before and after coverage by National Health Insurance (NHI) / 대한구강보건학회지

OBJECTIVES: The purpose of this study was to review the relationship between pit and fissure sealant (PFS) experience and the socio-economic factors of adolescents before and after coverage by National Health Insurance (NHI). METHODS: Our sources were the Korea Youth Risk Behavior Web-based Surveys from 2008 and 2014. The variables used were PFS experience, demographic factors, socio-economic factors, and oral health-related behaviors. RESULTS: PFS experience was higher in 2014 than in 2008. The relationship between PFS experience and socio-economic factors was significant in both 2008 and 2014. Although the inequity of PFS experience among adolescents was reduced as PFS was included in NHI coverage, a disparity still exists. CONCLUSIONS: Even after NHI coverage included PFS, the policies to reduce the inequity of PFS experiences among adolescents should be further devised. In addition, a longitudinal study is recommended to determine the relationship between PFS experience and various socio-economic or behavioral factors.

A Case Study on the Validity of Dental Communication Curriculum of a Dental Hygiene Department / 치위생과학회지

The purpose of this study was to examine the validity of the content of an educational curriculum by understanding the opinions of experts in the development of weekly educational content for dental communication or communication-related subjects. It was composed of educational content on how to communicate with patients by cultivating a professional attitude through basic contents and a self-understanding of communication. Three experts were asked to evaluate the feasibility of educational contents and their appropriateness in order to evaluate the criteria for certification as a dental hygienist. The validity of the weekly educational contents and the period of education were awarded 4 points out of a maximum of 5 points; overall, the curriculum was evaluated to be valid and to be acceptable for use as criteria for certification evaluation. On the other hand, it was confirmed that not only should the contents be made appropriate for the grade level, but it should be complemented so that theoretical and practical learning can be achieved in a gradual and interrelated manner rather than as a one-time curriculum. Therefore, the result of this study can be considered for use as background data for curriculum development, and for standardization of the communication course in the dental hygiene department.

Oral health literacy of mothers belonging to multi-cultural families in Gangneung City: a case study / 대한구강보건학회지

OBJECTIVES: The purpose of this study was to identify the oral health literacy level of mothers in multi-cultural families and promote their oral health. METHODS: Participants were 46 mothers belonging to multi-cultural families who participated in the Oral health promotion program for multi-cultural families in Gangneung. For measurement of oral health literacy, 30 subjects were analyzed. Six pre-trained investigators conducted an interview with the mothers. Thirty-six mothers belonging to general families in Gangneung were included, and 30 subjects were analyzed. The Oral Health Literacy Instrument for Korean Children's Caregiver was used. Data were analyzed using SPSS 20.0 (SPSS Inc., Chicago, IL, USA). RESULTS: The mean oral health literacy score for mothers from multi-cultural families was 10.83 out of 22.0, which was lower than the score for mothers from general families (P<0.05). The percentage of mothers from multi-cultural families whose oral health literacy was inadequate was 63.3%. Oral health literacy scores were significantly different by Korean fluency level (P<0.05). The correlation between Korean communication level and reading comprehension score was significant (P<0.01). The correlation between Korean communication level and total oral health literacy score was also significant (P<0.05). Finally, there was a significant correlation between oral health knowledge and reading comprehension (P<0.05). CONCLUSIONS: The oral health literacy score for mothers from multi-cultural families was lower than that for mother belonging to general families, and 63.3% had inadequate knowledge. Oral health professionals should use easy terms and consider the Korean communication capacity of mothers in their professional service.

Effectiveness and Learning Experience of Dental Communication Course Training in Dental Hygiene Schools / 치위생과학회지

The purpose of this study was to develop a dental communication course in dental hygiene schools that included theory, practice, and skill for effective dental communication. Thirty-six senior dental hygiene students in a dental hygiene school took a dental communication course and responded to a questionnaire. The instrument used in the study was a modified form of Kim's communication skill self-assessment sheet. The self-assessment questionnaire about communication competencies was administered before and after the class, and the difference between scores at each time point was analyzed using the Wilcoxon signed rank sum test. Among seven elements of dental communication competencies, the competency of “information gathering” was significantly improved (p=0.008). Students' scores on perception of the importance (p=0.019) and necessity (0.016) of a communication course significantly increased after the course. Competencies in communication are essential requirement for dental hygienists. This study showed the possibility of communication skill training. An objective evaluation tool regarding students' communication competencies should be developed. Further studies with larger samples size are needed to develop a standardized comprehensive communication course in dental hygiene schools.

Comparison of supplied amount of pit and fissure sealing on the first permanent molars by age and disparity of dental accessibility using National Health Insurance data / 대한구강보건학회지

OBJECTIVES: The purpose of this study was to review the supplied amount of pit and fissure sealing (PFS) by age and dental accessibility of children after PFS was included in the list of treatments covered by National Health Insurance (NHI). METHODS: The comparison period was selected by considering the availability of data and the initiated time of PFS inclusion into NHI. The selected data period after inclusion was 2010-2012. Data were collected from the NHI database. To categorize the areas by high and low dental accessibility, the number of dental institutions was standardized by population per width of area. RESULTS: Supplied amount of PFS to the first permanent molars in children aged 6 to 8 years constituted to about 70% of the total supplied amount during 2010-2012. However, this supplied amount was less than 8% of the total number of the first permanent molars in that age group. Number of supplied PFS for ages 6 to 8 years was 8.4% and 6.3% of the total number of first permanent molars for high and low dental accessibility areas, respectively. CONCLUSIONS: Although PFS supply was increased after inclusion in NHI coverage, it is still insufficient to reduce the decayed-missing-filled teeth (DMFT) index effectively. To increase the supplied amount of PFS and to reduce inequality of supply between areas of high and low dental accessibility, strengthening of and focus on education related to PFS, reduced out-of-pocket expenditure, and advocacy are needed for appropriate target age groups and areas.

Diagnostic predictability of self-reported questionnaire for periodontitis / 대한구강보건학회지

OBJECTIVES: The present study aimed to evaluate the validity of a set of self-reported questionnaires for periodontitis for estimating the prevalence of chronic adult periodontitis in the Korean population. METHODS: The questionnaire is comprised of a total of 14 questions with four summarized concepts including self-diagnosis of oral status, subjective signs related to oral health, smoking and drinking status, and use of auxiliary oral hygiene devices including scaling. The predictiveness of the measures from these self-reported questions was assessed by logistic regression modeling using receiver operating characteristic (ROC) statistics, sensitivity, and specificity. RESULTS: The sensitivity, specificity, and AUC including all questions were 0.571, 0.768, and 0.781, respectively; the sum of sensitivity and specificity was 1.34. To gain robustness, a simplified predictive model was built with six questions. Its results were 0.536, 0.817, and 0.762 for sensitivity, specificity, and AUC, respectively. The sum of sensitivity and specificity was found to be 1.35. CONCLUSIONS: The self-reported questionnaire for periodontitis showed considerable validity, but further study is required to provide optimal validity and predictability.

Changes in the amount of pit and fissure sealants supplied in Korea after inclusion in the National Health Insurance coverage / 대한구강보건학회지

OBJECTIVES: The purposes of this study were to review changes in the amount of pit and fissure sealant (PFS) provided after the inclusion of PFS in treatments covered by the National Health Insurance (NHI) and to assess differences in the supplied amount between geographical areas where accessibility to dental care differs. METHODS: The years for comparison were selected based on data availability and the time of inclusion of PFS into NHI coverage. The selected pre-inclusion year was 2008, and the post-inclusion year was 2012. Data regarding the amount of PFS supplied were collected from the oral health program, NHI, and Medical care. To dichotomize areas by high and low dental care accessibility, we standardized the population size, number of dental institutions, and number of dentists in each group. RESULTS: We considered metropolitan areas and Gyeonggi Province as high dental care accessibility areas, while other provinces were considered as low dental care accessibility areas. Regardless of the transforming constant, the amount of PFS supplied increased in high dental care accessibility areas and decreased in low dental care accessibility areas after inclusion of PFS in NHI. CONCLUSIONS: To increase the amount of PFS provided in low dental care accessibility areas, promotion of PFS should be strengthened and support from oral health programs should be increased. Additionally, waiving out-of-pocket money for PFS in NHI should be considered to remove barriers of supply.

Validity and reliability of a questionnaire for evaluating periodontal disease / 대한구강보건학회지

OBJECTIVES: The purpose of this study was to develop a self-administered questionnaire survey to determine its validity and reliability as well as to improve the instructions for measurement of periodontal disease during oral examination for reliably calculating the prevalence of periodontal disease. METHODS: The data obtained was analyzed using SPSS 20.0 and the WINSTEPS program that employs the Rasch model to evaluate validity and reliability of the instrument. RESULTS: We developed a self-administered questionnaire survey consisting of 14 questions based on NHANES. We confirmed the reliability by testing and re-testing the questionnaire survey using selfadministered methods. The average Kappa index obtained was 0.73, which indicated a relatively high reliability. CONCLUSIONS: Reliability and validity of the self-administered assessment tool for periodontal disease developed for the local situation/circumstances of Korea is suitable to be applied for oral examination of a large population. Moreover, the questionnaire survey for periodontal disease could be used to acquire data for constructing a database for oral health policy development.

Education on National Health Insurance: experience of Korean dentists who secured a license during 2000-2004 / 대한구강보건학회지

OBJECTIVES: The purpose of this study was to investigate Korean dentists' perceived experience with and contents of education on National Health Insurance, and their competence in the practice of cases involving a health insurance claim. METHODS: A survey was conducted with 600 dentists who secured their dentist license during 2000-2004. A systemic stratified sampling, with "school graduated from" as a stratum, was conducted on a population of 3,947 dentists, using the register of the Korean Dental Association. A survey request and questionnaire sample was mailed, and responses were collected using a web-based replying method. The impact of the experience of education related to health insurance on the frequency of, and perceived competence on health insurance claims was analyzed using the chi-square test. RESULTS: Only 21% dentists replied that they had educational experiences related to health insurance when they were dental students, and the content of this education was 'health insurance system' (69%) and 'health insurance law' (59%). Only 28% of the respondents replied that they had practiced cases related to health insurance claims at dental schools. The rate of dentists who had educational experiences related to health insurance after their graduation was 73%. The experience of education related to health insurance and the perceived competency on handling health insurance claims showed a statistically significant correlation (P<0.01). CONCLUSIONS: It is necessary to develop a standardized curriculum related to health insurance and health insurance claims in dental schools.

Clusters of oral health-related behaviors by gender and their relationship with psychosocial factors for adolescents in Gangneung / 대한구강보건학회지

OBJECTIVES: To verify the clusters of oral health-related behaviors by gender for adolescents in Gangneung, and to assess the influences of psychosocial factors (family socioeconomic status factors, individual economic factors, and psychological factors) on these clusters. METHODS: A survey was conducted of 3,611 adolescents (6th grade students in primary school, 2nd grade students in middle school, and 2nd grade students in high school) in Gangneung. The response rate was 96.6% (1,846 boys; 1,765 girls). The data were collected via self-administered structured questionnaires assessing participants 'smoking experience,' 'tooth brushing,' 'consumption of crackers or soft drinks,' and 'consumption of fruits or vegetables.' K-means cluster analysis was used to cluster the oral health-related behaviors by gender. A chi-square test was used to assess the difference between the clusters for oral health-related behaviors by gender and psychosocial factors. RESULTS: Clusters of oral health related-behaviors were classified into the unhealthy group (group 1; bad oral health-related behaviors), healthy group (group 2; good behaviors), and complex group (group 3; low smoking experiences and complex other behaviors). The clusters were different by gender. In the unhealthy group, boys represented 19.9% while, in the healthy group, girls represented 47.3%, which are both higher than the theoretical rates. Psychosocial factors in the unhealthy group were significantly lower than the healthy group (P<0.05). CONCLUSIONS: Meaningful clusters of oral health-related behaviors by gender were identified. Furthermore, the clusters were different by psychosocial factors. This finding suggests that one of the best ways to enhance oral health for adolescents is to develop oral health promotion programs for each oral health-related behavior cluster.

Abrasion of resin infiltrated enamel by tooth brushing / 대한구강보건학회지

OBJECTIVES: The purpose of this study was to evaluate abrasion of Icon(R) infiltrated, sound bovine enamel by using confocal laser scanning microscopy (CLSM) after toothbrush abrasion tests. METHODS: Sound bovine enamel specimens whose Vickers Hardness Number ranged from 280 to 320 were prepared. To measure abrasion, specimens were allocated to groups on the basis of tooth brushing stroke frequencies. Tooth brushing stroke frequencies were categorized into 5 groups: 1,800, 5,400, 10,800, 21,600 and 43,200 strokes. Both infiltration depth of Icon(R) and the abrasion depth were measured by CLSM. RESULTS: Mean infiltration depth of Icon(R) for sound bovine enamel was 98.6 microm. There was no statistically significant difference in enamel abrasion depth between groups with 5,400 strokes and 10,800 strokes, but the abrasion depth increased with further increase in tooth brushing stroke frequencies (P<0.001). The mean abrasion depth of resin infiltrated bovine enamel after 43,200 tooth brushing strokes was 17.45 microm. CONCLUSIONS: The magnitude of abrasion after 43,200 tooth brushing strokes, which corresponds to brushing 3 times a day for 4 years, was less than 20 microm. This result suggests that abrasion by tooth brushing would not be a clinical problem for resin infiltrated enamel.

One-year outcomes and reasons for dropout in participants of the continuous dental care program of the Community Child Center in Gangnueng city / 대한구강보건학회지

OBJECTIVES: This study aimed to determine the effectiveness of the continuous dental care program of the Community Child Center in Gangneung city by evaluating one-year outcomes and determining the reasons for dropout. METHODS: A total of 180 children in the study group were provided with continuous dental care in 2008. The control group consisted of 131 children whose 2009 dental records from Gangneung-Wonju National University Dental Hospital were retrospectively reviewed. The outcome of dental caries prevention was evaluated by prevalence rates and number of decayed teeth. The evaluation of dental care outcome was based on cost and frequency of dental care. A chi-square test and Mann-Whitney U test were used to assess differences between the study group and the control group. In addition, the dropout rate and the reasons for dropout by the time of dental service supply were investigated for 427 children who participated in this program in 2010. RESULTS: Dental caries prevention results of the study group were better than those of the control group, but significant differences were found only in the dt rates of girls (P<0.001). The average frequency of dental care per child in the study group was lower than that of the control group. The average cost of dental care per child was 56,910 won per boy in the study group, 124,893 won per boy in the control group, 71,657 won per girl in the study group, and 127,296 won per girl in the control group. Significant differences in dental care results were found for both boys and girls (P<0.05). The reasons for dropout were leaving the center, absence, use of another dental clinic, parents' or child's rejection of the program, and disability. CONCLUSIONS: On the basis of these results, we could logically assume that promoting oral health and reducing the cost of dental care might be achieved through the introduction of a continuous dental care program for vulnerable children and adolescents in the community.

Comparison between the National Oral Health Survey Systems of the United States and South Korea / 대한구강보건학회지

In Korea, two kinds of National oral health surveys have been conducted to develop various oral health indices during the past decade. The system still needs to be improved further in terms of quality control for the examination system, data management, personnel empowerment, etc. Therefore, this study compares the National Oral Health Survey system of the United States (US) with that of South Korea. The US national surveys related to oral health were set from the 1970s, whereas Korea's national surveys have been initiated only recently; consequently, the US system is well organized and systematically managed by the professional personnel in governmental institutes, such as the Division of Oral Health in Centers for Disease Control. Furthermore, this study examines the scope of the examiner training program, and the methods for developing and implementing a standardized examination environment, data quality control, a data input system with automatic error checking, and data back up in the US. Considering the various factors involved in conducting nationwide epidemiological surveys as mentioned above, the structure and implementation methods of oral surveys in Korea clearly need to be improved.

The remineralization effect of topical fluoride agents on artificial enamel caries / 대한구강보건학회지

OBJECTIVES: The aim of this study was to compare the remineralization effect of the topical fluoride agents on artificial enamel caries, under the chemical pH cycling model, using surface microhardness. METHODS: Bovine enamel specimens, embedded in acrylic resin with the labial surfaces exposed, were developed artificial enamel caries. Thereafter, this study used 56 samples on VHN 25-45. The experimental groups were divided into 4 groups: control, 2% NaF solution, 1.23% APF gel, 5% NaF varnish. Samples, except in the control group, were applied to each topical fluoride agent for 4 minutes. All groups were exposed to a pH cycling model, which consisted of demineralization (4 hours) and remineralization (20 hours) for 17 days. The Vickers surface microhardness number (VHN) was measured, using the microhardness tester. The results were analyzed, using a repeated measures analysis of variance of a general linear model, and compared the baseline, each day, using a contrast analysis (simple) about within a subject factor at a significance level of 0.05. RESULTS: Result of a repeated measures analysis regarding the surface microhardness of topical fluoride agents, there were significant differences at P-values of within and between the subject factor (P0.05). CONCLUSIONS: In this study, although there were significant differences at P-values of within and between the subject factor, there were no significant differences between the experiment groups on chemical pH cycling model in vitro, and it was limited to utilize this result in a clinical situation of the fluoride application.

Prevalence of demand for dentures in Korean elderly receiving governmental support funds / 대한구강보건학회지

OBJECTIVES: This study was conducted to investigate the status of elderly dentures wearers and to understand the relationship between elderly welfare recipients and general elderly Koreans. METHODS: A total of 3,810 subjects (3,458 general elderly and 352 elderly welfare recipients) over 65 years who participated in the Forth Korea National Health and Nutrition Examination Survey were examined. Oral examinations were conducted to ascertain those that were wearing dentures and those that needed dentures. A questionnaire measured chewing ability, concern about oral health, oral health behaviors, pronunciation ability and socio-demographic characteristics. The statistical analysis was done by using the SPSS 19.0 program. RESULTS: In the elderly welfare recipients, 28.2% was maxillary and 19.2% was mandible complete dentures and 36.0% had unmet denture treatment needs. In the general elderly, 21.7% was maxillary and 13.9% was mandible complete dentures and 24.3% had unmet denture treatment needs. The unmet denture treatment need in elderly welfare recipients was significantly higher than the general elderly after adjusting for other covariates. CONCLUSIONS: A denture service program is necessary for the elderly welfare recipients' oral health.

The differences of oral health-related behaviors by type of school among high school students in Gangneung city / 대한구강보건학회지

OBJECTIVES: The principle purpose of this study was to investigate the differences of oral health-related behaviors by a type of school among high school students in Gangneung city. The secondary purpose was to assess the influences of other factors (father's education status, mother's education status, subjective economic status, FAS, experienced part-time job, pocket money and perceived stress) on these differences. METHODS: A cross-sectional survey of 1,282 high school students was conducted in Gangneung city. The response rate was 93.4%; general high school students were 773 and vocational high school students were 509. The data were collected by self-administered structured questionnaires. The differences of oral health-related behaviors of high school students by school type were assessed by a chisquare test. Logistic regression models were used to analyze the influences of other factors on these differences. RESULTS: Oral health-related behaviors were markedly better in students attending general high school, rather than vocational high school (P<0.001). The differences of oral health-related behaviors by school type were persisted after adjusting for gender (Model 1), socio-economic factors (Model 2), part-time job and pocket money (Model 3), psychological variables (Model 4) and all variables (Model 5), except for visiting a dental clinic. CONCLUSIONS: We found a marked influence of school type in oral health-related behaviors. This finding suggests that school type is a risk factor of oral health-related behaviors in high school students. Therefore, one of the best ways to enhance oral health for high school students is to develop oral health promotion programs for vocational high school students.

Effect of the bleaching light on whitening efficacy / 대한치과보존학회지

The aim of this study was to evaluate the influence of light energy on the tooth whitening effect of bleaching agent in vitro. Extracted human mandibular molars were sectioned to 2 fragments(mesial, distal) and lingual portions of crown were used in this study. All specimens were stained using a red wine for 24 hours and immersed in artificial saliva. Specimens divided into four groups, group 1 and 2 light-activated by LumaCool (LED, LumaLite, Inc., Spring Valley, USA), group 3 and 4 light-activated by FlipoWhite2 (Plasma acr lamp, Lokki, Australia). Group 1 and 3 bleached with LumaWhite(LumaLite, Inc., Spring Valley, USA), group 2 and 4 bleached with Polaoffice(SDI, Victoria, Australia). Bleaching treatment performed during 10 minutes every 24 hours and repeated 6 times. During bleaching treatment , distal fragments was light-activated(L) but mesial fragments was not(NL). Shade assessment employed before and after bleaching treatment using spectrophotometer. The results of the change in shade was compared and analysed between NL and L by using paired-sample T test with 95% level of confidence. There were no significant differences between NL and L with a few exceptions. In group 2, a* value more change in L, in group 3, b* value more change in L, in group 4, a* value less change in L. After bleaching, L* value and DeltaE increased in all groups and the value of a* and b* decreased in all groups. Within the limitation of this test conditions, the results of this study indicate that the light energy has no obvious improving impact on the tooth whitening effect of a bleaching agent.