A Qualitative Study of Preschool Children's Perspectives on an Oral Health Promotion Program in New South Wales, Australia.

In Australia, dental caries are observed in almost half of children starting school. Oral health promotion programs are being implemented in early childhood education and care (ECEC) settings to promote oral health. This study examined children's perceptions of one such program, the Bright Smiles Bright Futures (BSBF) program in ECEC settings in New South Wales, Australia. Data were collected using focus group discussions from 15 children aged 3-5 years, transcribed verbatim, and analysed through inductive thematic analysis. Three themes were identified as follows: (i) oral health knowledge of children, (ii) oral hygiene practices routine and skills development, and (iii) evaluation of the oral health promotion kit and opportunities for improvement. Children's perspectives highlight the BSBF program's success in communicating key messages to promote oral health. The integration of family-centric approaches, acknowledgement of children's preferences, and the use of interactive tools collectively enhance the overall effectiveness of the oral health promotion program.

The Indigenous Adolescent Oral Health Partnership Study: A Co-Design Study Protocol.

BACKGROUND: in this protocol we outline a method of working alongside Aboriginal communities to learn about and facilitate improvement in the oral health habits in Aboriginal adolescents. By facilitating positive oral health in Aboriginal adolescents, we hope to achieve lifelong improvement in oral health and general wellbeing. METHODS: this paper outlines a co-design methodology through which researchers and Aboriginal communities will work together to create a custom oral healthcare program aimed at Aboriginal adolescents. Researchers, a youth advisory group, Aboriginal community-controlled health services and three regional NSW communities will together devise an oral health strategy focused on five components: application of topical fluoride, increasing water consumption, improving nutrition, daily toothbrushing, and enhancing social and emotional wellbeing. Capacity building is a key outcome of this program. DISCUSSION: as the gap in health status between Aboriginal and non-Aboriginal people remains wide, it is clear that new approaches and attitudes are needed in Aboriginal public health research. This protocol is representative of this shifting approach; giving power to Aboriginal communities who seek to have sovereignty and self-determination over their healthcare. TRIAL REGISTRATION: TRN: ISRCTN15496753 Date of registration: 20 October 2021.

Barriers and enablers in the implementation and sustainability of toothbrushing programs in early childhood settings and primary schools: a systematic review.

BACKGROUND: Untreated dental caries negatively impacts a child's quality of life including overall health and wellbeing, growth and development, social interaction ability, and school attendance. School-based toothbrushing programs have been recognised as an effective intervention to reduce the burden of dental caries. However, limited information is available to understand the real-world enablers and challenges in the implementation and sustainability of toothbrushing programs. This review aims to understand the barriers and enablers in the implementation and sustainability of toothbrushing programs in early childhood settings and primary schools. METHODS: Five electronic databases [i.e., CINAHL (EBSCO), Medline (EBSCO), EMBASE (Ovid), Web of Science, and PsycINFO] and backward citation chasing were performed. The last updated databases searches were conducted in May 2022. Studies reporting on barriers and enablers in the implementation and sustainability of toothbrushing programs in early childhood settings or primary schools were included in the review. The methodological quality of included studies was assessed by using Joanna Briggs Institute [JBI] and mixed methods appraisal tool [MMAT] critical appraisal tools and results were reported in accordance with PRISMA guidelines. RESULTS: A total of six studies met the eligibility criteria and were included in the review. Toothbrushing programs in early childhood settings and primary schools were mostly implemented under the supervision of staff and teachers. A positive attitude of the staff, the flexibility of toothbrushing sessions, involvement of community volunteers and parents were a few of the identified enablers. However, the timing of the communication of the program, inadequate transfer of information among staff, frequent staffing turnover, lack of parental support, and staff feeling overburdened while acting as pseudo parents were frequently reported as barriers. CONCLUSION: The results of this systematic review identify key enablers and barriers for toothbrushing programs in early childhood settings and primary schools which need to be considered for developing oral health promotion initiatives.

A Markov cost-effective analysis of biannual fluoride varnish for preventing dental caries in permanent teeth over a 70-year time horizon.

ISSUE ADDRESSED: Biannual application of fluoride varnish is effective for dental caries prevention, but its cost-effectiveness using quality-adjusted life years (QALY) is unknown. This study performed a cost-effectiveness analysis, from the Australian health care system perspective of biannual application of fluoride varnish versus current practice (non-routine application) for an individual aged 15 years and older over a 70-year time horizon. METHODS: Health outcomes measured were the number of prevented decayed, missing, and filled teeth (prevented-DMFT) and QALY gained. The calculated incremental cost-effectiveness ratio (ICER) was compared against the reference cost-effectiveness ICER threshold of AUD$28 033 per QALY gained. A published Markov model capturing dental caries progression of eight permanent molars was used. This 6-monthly cycle model represented ten possible health states for an individual tooth. A 5% discount rate was applied with relevant sensitivity analysis. RESULTS: In the base-case scenario, the net cost for the intervention was $3600 compared to $2303 in the current practice arm. The intervention arm yielded 13.99 DMFT and 15.44 QALY gained, whereas the current practice arm yielded 15.52 DMFT and 14.74 QALY gained. The estimated ICER was $849 per prevented-DMFT and $1851 per QALY gained. Sensitivity analysis shows the ICER ranged from $424-$1807 per prevented-DMFT and $1851-$3941 per QALY gained. CONCLUSION: Biannual professional application of fluoride varnish appears to be a highly cost-effective strategy and should be considered for universal funding in Australia's health care system.

Maternal self-report of oral health in six-year-old Pacific children from South Auckland, New Zealand.

OBJECTIVE: To examine maternal and socio-demographic factors associated with oral health practices and experiences in six-year-old Pacific children. METHODS: The longitudinal Pacific Islands Families (PIF) study is following a cohort of Pacific children born in Auckland, New Zealand in 2000. At approximately six years postpartum maternal reports (n = 1001) on child oral health practices and experiences of fillings and extractions were gathered. RESULTS: Forty-five per cent of mothers reported that their child had experienced fillings or extractions. After adjusting for confounding factors, we found that Tongan children were almost twice as likely to have their teeth filled or extracted than Samoan children (OR, 1.93; 95%, 1.34-2.77). Differences between Samoan children and children of other ethnic groups were not significant. Children of mothers who had secondary qualifications were significantly less likely to have their teeth filled or extracted compared to children of mothers who had postsecondary qualifications (OR, 0.634; 95%, 0.44-0.90). Prolonged duration of breastfeeding was associated with an increased likelihood of filling or extraction experience. In terms of maternal oral hygiene, maternal tooth brushing frequency of less that once a day was significantly associated with increased odds of fillings and/or extractions in their children (OR, 1.35; 95% CI, 1.02-1.79). Children who were sometimes supervised for tooth brushing were significantly more likely to have fillings or extractions than children who were not provided supervision. CONCLUSIONS: These findings highlight the role of cultural factors and maternal hygiene in child oral health outcomes and suggest that health promotion efforts should encompass the whole family and embrace a culturally appropriate approach.

Maternal self-report of oral health in 4-year-old Pacific children from South Auckland, New Zealand: findings from the Pacific Islands Families Study.

OBJECTIVES: To report on the oral health risk in a disadvantaged group of 4-year-old Pacific children and their mothers living in South Auckland, New Zealand. METHODS: The Pacific Islands Families study follows a cohort of Pacific infants born in 2000. Maternal self-report of mother and child's oral health practices and child's filling and extraction experience was undertaken at interview approximately 4 years postpartum. RESULTS: Overall, 1,048 mothers of children were interviewed. Children's reported oral health practices were generally poor, with 47 percent brushing < or =1/day, 47 percent having no adult assistance with brushing, 57 percent routinely snacking or drinking immediately prior to bed, and 26 percent yet to receive their first dental checkup. Maternal practices were also poor, with 34 percent brushing < or =1/day and 50 percent having never seen or last visiting a dentist over 5 years ago. Significant differences were seen in many practices between the major ethnic subgroups. Of children attending the school dental service, 22 percent were reported having at least one filling and/or extraction. In multivariable analyses, variables corresponding to mother's toothbrushing frequency, child snacking or drinking prior to bed, and duration of breastfeeding were significantly associated with reported filling and/or extraction experience; but no difference was seen between the three major maternal ethnic subgroups. CONCLUSIONS: Many mothers and their Pacific children have poor basic oral hygiene and dietary practices that increase the oral health risk in these children. Culturally appropriate and targeted strategies aimed at these modifiable practices need to be widely promoted so that the oral health burden carried by Pacific children can be reduced.

Comparative tooth whitening efficacy of 18% carbamide peroxide liquid whitening gel using three different regimens.

OBJECTIVE: Recently, a novel paint-on liquid whitening gel--Colgate Simply White Clear Whitening Gel--which contains 18% carbamide peroxide, has been developed as a self-administered tooth bleaching system. The purpose of the present study was to determine the efficacy and safety of this product using alternate exaggerated or simplified treatment regimens. METHODOLOGY: This was a three-week clinical trial using a parallel, double-blind, stratified protocol with three different instructions for application: 1) twice-daily, no air-drying, and 15 minutes without eating/drinking; 2) three times daily, 30-second air-drying and 30 minutes without eating/drinking; or 3) four times daily, 30-second air-drying and 30 minutes without eating/drinking. One-hundred and twenty (120) healthy volunteers were balanced into three equal groups based on shade scores (A3 or darker). Clinical evaluations (shade guide, oral tissue health, gingival index and visual analog sensitivity score) were performed on each group at baseline and weekly for the next 21 days. At the conclusion of the study, a survey of the subjects' opinions on their assigned product regimen was also conducted. RESULTS: Subjects who used Colgate Simply White Clear Whitening Gel three and four times daily achieved the greatest shade improvement (5.88 +/- 1.53 shades, and 5.57 +/- 1.54, respectively). However, these values were only about one shade better than the value observed for the more convenient, twice-daily, "no-dry" regimen (4.51 +/- 1.77 shades), though they were statistically significant (p < 0.05). The result for the four-times daily protocol was not statistically different from the three-times group. Also, no differences were observed between the groups concerning oral tissue health, gingival index or tooth sensitivity, and no adverse effects were observed or reported regardless of the regimen used. Surveys completed by the subjects showed that those who used the twice-daily, "no-dry" regimen found the product to be the easiest to use, the most comfortable and the most pleasant tasting. CONCLUSION: It can be concluded from the clinical data that three or four applications of Colgate Simply White Clear Whitening Gel per day provided better efficacy. In addition, the use of the whitening gel twice daily, even without "dry time" and only 15 minutes without eating/drinking, yielded results that were comparable to previously reported results using the original on-label directions. The potential additional benefit to the "simplified regimen" is that it was perceived to be the most convenient and comfortable. The use of Colgate Simply White Clear Whitening Gel up to four times daily for up to three weeks is also safe, and the tendency of abusing the product with more frequent daily use may be deterred by the inconvenience reported by the study subjects.

Comparison of clinical efficacy and safety of three professional at-home tooth whitening systems.

A three-cell, randomized, parallel, investigator-blinded clinical trial was conducted to compare the efficacy and safety of three professional at-home tooth whitening systems, including Crest Professional Whitestrips (6.5% H2O2), Day White 2 (7.5% H2O2) and Nite White Excel 2 (16% carbamide peroxide equivalent). Ninety subjects were randomly assigned to three groups (30/group). Subjects were instructed to use the assigned whitener following the manufacturers' instructions. Clinical examinations at baseline, and on days 3, 7, 14, and 18 (Day White), or 21 (Crest Professional Whitestrips and Nite White) included the following parameters: 1) oral tissues; 2) tooth shade by the Vitapan Classical shade guide; 3) tooth shade by a chromameter with a jig; and, 4) tooth sensitivity and gingival irritation. The results showed significant shade reductions with time in all three groups. Nite White resulted in significantly greater shade reductions in periods between days 7, 14, or 21 and baseline than did the other two systems. Tooth sensitivity and gingival irritation, which were mostly mild and transient, occurred in all groups. It is concluded that all three whitening systems evaluated are effective and safe. Nite White Excel is superior to the other two systems because it provides a greater whitening efficacy with comparable or lower incidence of tooth sensitivity and gingival irritation.