Development and validation of the Iranian version of the Children's Experiences of Dental Anxiety Measure (CEDAM).

OBJECTIVE: The aim of this study was to develop the Iranian version of the Children's Experiences of Dental Anxiety Measure (CEDAM) and evaluate its validity and reliability in assessing dental anxiety in children aged 9-16. METHODS: The CEDAM was translated into Persian following the guidelines of the IQOLA project. A sample of children completed the measure in a clinical setting, with a subgroup completing it again to assess test-retest reliability. Concurrent criterion validity was evaluated by having all participants complete the Modified Child Dental Anxiety Scale (MCDAS) alongside the CEDAM. Construct validity was examined using exploratory and confirmatory factor analyses. RESULTS: The study included 275 children between the ages of 9 and 16. The Iranian version of CEDAM exhibited excellent internal consistency with a Cronbach's ⍺ coefficient of 0.83. Test-retest  reliability was also high, with an intraclass correlation coefficient value of 0.96. Furthermore, there was a significant and positive correlation between CEDAM and MCDAS scores (ρ = 0.72, p < .01). Exploratory factor analysis identified two factors, and confirmatory factor analysis confirmed that the instrument aligned well with the factor structure obtained from the exploratory analysis. CONCLUSION: This study provides evidence supporting the validity and reliability of the Iranian version of CEDAM as a valuable tool for evaluating dental anxiety in Persian-speaking children between the ages of 9 and 16. .

Design, Implementation, and Evaluation of Educational Program in Oral Health for Midwives and Other Antenatal Care Providers in Iran.

Background: Maintaining oral health during pregnancy has been considered an essential public health issue worldwide. One of the various preventive strategies is to train antenatal care providers to guide pregnant women. This study aimed to design, implement, and evaluate an educational program's effect on the oral health-related knowledge, attitudes, and practice of antenatal care providers in Iran. Materials and Methods: All of the antenatal care providers working at Isfahan health centers were invited for this study in April 2019. A total of 340 volunteers (120 midwives and 220 others) finally participated in this interventional study with a pre-test-post-test design. A questionnaire was developed to assess the participants' knowledge, attitudes, and practice before and after the intervention. A lecture-based educational session containing similar issues asked in the questionnaire was held for all the participants. The participant's total knowledge scores before and after the intervention, and their attitudes and practice were evaluated and compared through paired t-test. Results: The participants' mean total knowledge scores before and after the intervention were 42.87 and 52.25, respectively. The paired t-test revealed a statistically significant difference between pre- and post-intervention scores (p < 0.001). The frequency of participants' answers to attitude and practice questions was also determined. Conclusions: Improving oral health-related knowledge of antenatal care providers can be achieved through a single educational session designed by accurately assessing their needs. The participants' attitudes revealed barriers to seeking dental care by pregnant women; however, the participants' oral health-related practice was acceptable.

Evaluation of last-year dental students' knowledge of prescription of analgesics and anti-bacterial agents for pregnant and lactating women

Oral health in pregnant and lactating women can affect maternal and child health. Dental treatments in this period should not have adverse effects on maternal and child health. This study was conducted to investigate the last-year dental students' knowledge of the prescription of analgesics and antibiotics for pregnant and lactating mothers in Isfahan city, Iran. Methods: A total of 104 last-year dental students of Khorasgan Islamic Azad University and Isfahan University of Medical Sciences were recruited in this descriptiveanalytical study. They completed a 16-item questionnaire on the prescription of analgesics and antibiotics for pregnant and lactating mothers. Data were analyzed by SPSS (Version 22) statistical software(t-test). Results: The total mean score of students' knowledge was 9.02±1.91. The highest level of knowledge about the safest analgesic (acetaminophen) was reported for the pregnant patients so that 100% of them had correct information in this regard. Further, the lowest level of knowledge was found for the use of dexamethasone during lactation, as only 10.6% of respondents were able to provide a correct response in this regard. Conclusion: The dental students had average knowledge about the prescription of antibiotics and analgesics for pregnant and lactating patients. To prevent the possible risks for these patients, further information should be provided to dental students

Toothbrushing and related factors among high school students in the Southeast of Iran: A cross-sectional study.

INTRODUCTION: Dental caries is one of the most common problems in student, and tooth brushing at least twice a day is one of the preventive measures of dental caries. This study aimed to determine the frequency of daily brushing and its related factors among high school students in the southeast of Iran based on the Health Action Process Approach (HAPA). METHODS: In this cross-sectional study, 2045 high school students of 13-15 years from urban areas of Zahedan in the southeast of Iran with multistage random sampling were selected. A self-administered questionnaire was used to assess demographic background, psychosocial constructs of the HAPA and daily brushing frequency. Binary logistic regression analysis was performed to determine predictors of daily brushing. RESULTS: Only 18% of participants reported tooth brushing at least twice a day, which is the desired brushing behaviour. Multivariate regression showed that increased odds of daily brushing associated with gender (OR = 2.38, 95% CI 1.84-3.08), mother education (OR = 2.27, 95% CI 1.62-3.18), father job (OR = 2.24, 95% CI 1.20-4.19), task self-efficacy (OR = 1.24, 95% CI 1.08-1.42), action planning (OR = 1.10, 95% CI 1.02-1.19) and maintenance self-efficacy (OR = 1.20, 95% CI 1.13- 1.27). CONCLUSION: The brushing behaviour of students needs to be taken seriously in Zahedan. Motivational and volitional constructs of the HAPA include task self-efficacy, action planning, and maintenance self-efficacy could be considered in intervention programmes targeting increase adolescent brushing.

Fissure sealant therapy as a portable community-based care in deprived regions: Effectiveness of a clinical trial after 1 year follow-up.

The aim of this study was to evaluate the effectiveness of the fissure sealant therapy in suboptimal setting (as part of a community-based program using the portable equipment and provided by dental students) on the caries status of school children. This pragmatic split-mouth randomised clinical trial was conducted in rural area of Iran. At baseline, 124 patients, including 185 paired teeth with deep pits and fissures of opposite quadrants that were either healthy or at early stages of enamel decay (International Caries Detection and Assessment System [ICDAS] 0-2), were randomly allocated to receive fissure sealant or acted as control. The incidence of new caries (ICDAS code 3-6) and the sealant's retention status after 1-year follow-up were evaluated. Using chi-square test, the relative risk (RR) and the Number Needed to Treat (NNT) to prevent new caries were calculated. After 1 year, 109 patients including 163 paired teeth were available. Sixty-seven (41.4%) and 44 (27.2%) teeth had complete and partial retained sealants respectively. The risk of caries incidence in non-sealed teeth was almost three times more than sealed teeth (RR = 2.88, 95% CI: 1.4-1.97, p = 0.002) and the NNT was 10 (95% CI: 6-26). A significant association was noted between the status of sealant retention after 1 year and the incidence of new caries (p < 0.001). Fissure sealant as part of a community-based program was effective in controlling caries incidence.

The impact of pregnancy on women's oral health-related quality of life: a qualitative investigation.

BACKGROUND: Complex psychological and physiological changes occur in women's body during pregnancy. These changes affect both oral health status and oral health-related quality of life (OHRQoL). In almost all of the previous cross-sectional design studies on pregnant women, generic OHRQoL instruments have been used to measure OHRQoL. While such instruments may be reliable, they may not be appropriate to evaluate the OHRQoL in special populations like pregnant women. The purpose of this study was to investigate the self-perceived factors affecting the OHRQoL among pregnant women. METHODS: In this qualitative descriptive study, twenty- seven pregnant women were recruited from four healthcare centers located in Isfahan city, Iran. The interpretative phenomenological analysis was used to collect and analyze the data. Four criteria of credibility, dependability, transferability, and confirmability were implemented through established procedures to confirm the study rigor. RESULTS: Three major themes and six sub-themes capturing the impacts of pregnancy on women's OHRQoL were identified. They covered all areas of life, including daily life, psychological well-being, social life, physical impact, and also barriers to utilization of dental care services. Some new domains such as "dentists' refusal to treat pregnant women", "negative feelings about pregnancy" and "concerns about fetal health" were found as important factors which could influence the OHRQoL during pregnancy. CONCLUSION: The findings help to better understand the oral health issues impacting women during pregnancy and to achieve person-centered care and improved oral health outcomes in pregnant women. The conceptual framework created based on the results of this study may help health care workers and policy makers for improving the health of pregnant women.

Oral Health-Related Quality of Life during Pregnancy: A Systematic Review.

OBJECTIVE: High prevalence of Dental and periodontal problems during the gestation period may have a negative effect on oral health-related quality of life (OHRQoL) in pregnant women. This systematic review aimed to perform a quality assessment and provide a critical overview of the current research available on OHRQoL in pregnant women. METHODS: For this systemic review, all original and peer-reviewed human studies, which investigated OHRQoL of women during pregnancy or post- partum period, were searched. Studies were screened in title and abstract for the relevance by two independent investigators. Methodological quality was assessed using modified items recommended by the Newcastle-Ottawa Scale for observational studies. RESULTS: All of the eight included studies had a cross-sectional design. Meta-analysis was not possible due to the heterogeneity of key aspects among the included studies. Thus, the data from the studies were evaluated qualitatively. The overall risk of bias of the included studies was low. CONCLUSION: The main conclusion of this review is that the presence of signs and symptoms of dental and gingival disease negatively affects the self-perception of OHRQoL in pregnant women. The most affected domains of OHRQoL in pregnant women were related to mental and psychological discomfort, followed by physical and functional problems.

Serum, saliva, and GCF concentration of RANKL and osteoprotegerin in smokers versus nonsmokers with chronic periodontitis.

BACKGROUND: The role of host response in periodontitis pathogenesis is confirmed, and it is well established that immune response plays a major role in the alveolar bone destruction. In the investigation of these responses, the role of receptor activator of the nuclear factor-kB ligand (RANKL)-osteoprotegerin (OPG) system is the most promising. Smoking can affect the RANKL-OPG system in a manner that will further enhance bone loss in periodontitis. The aim of this study is to assess the serum, saliva, and gingival crevicular fluid (GCF) concentration of RANKL and OPG in smoker versus nonsmoker untreated chronic periodontitis (CP) patients. MATERIALS AND METHODS: Thirty-nine subjects were included in the present cross-sectional study: 29 systemically healthy CP male patients (15 smokers, 14 nonsmokers) and 10 systemically and periodontally healthy nonsmoker male subjects. Serum, GCF, and whole saliva samples were obtained from the subjects. The enzyme-linked immunosorbent assay (ELISA) kits were used for assaying the concentrations of RANKL and OPG in the samples. The one-way analysis of variance (ANOVA) test and the least significant difference (LSD) post hoc test were utilized to compare differences between the groups. RESULTS: RANKL and OPG concentrations in saliva, serum, and GCF did not show any significant difference among all groups (P > 0.05). Salivary RANKL/OPG ratios were significantly higher in the nonsmoker CP group than in the healthy control group (P > 0.05) but they were not statistically significant among smoker periodontitis patients. CONCLUSIONS: The salivary RANKL/OPG ratio was higher in nonsmokers with periodontitis in comparison with smoker periodontitis patients.

Change in Conceptions of Iranian Pre-adolescents' Oral Health After a School-based Programme: Challenge for Boys.

PURPOSE: To determine the role of pre-adolescents' conceptions in improving their oral health in a school-based health education programme. MATERIALS AND METHODS: A school-based programme was designed as a 3-month intervention study for a representative sample of 9-year-olds (n = 338) in 12 schools in Tehran, Iran. The schools were randomly assigned to the intervention groups and controls, separately for boys' and girls' schools. Children (n = 222) underwent two kinds of oral health education programmes. The control group (n = 116) had no intervention. Positive changes in the child's oral health conceptions were evaluated after the programme as determinants of each child's oral health. Final effects of the intervention were assessed as improvements in gingival health when all index teeth with bleeding at baseline became healthy (healthy gingiva). Statistical analysis included chi-square, independent samples t-test and logistic regression models. Factor analyses were applied to the child's oral health conceptions. RESULTS: Three factors regarding the children's oral health conceptions emerged. After the programme, boys and girls in the intervention group experienced fewer barriers to dental care than did the controls. Healthy gingiva was apparent among the boys (OR = 2.0) and the girls (OR = 4.1) in the intervention group. Girls experienced fewer barriers to dental care after the programme (OR = 1.5) and achieved more healthy gingiva, but boys' oral health conceptions showed no effect on the health of their gingiva. CONCLUSION: In designing health education programmes, in addition to other determinants, pre-adolescents' oral health conceptions deserve consideration. Intervention planning necessitates awareness of gender differences.

Mothers as facilitators of preadolescents' oral self-care and oral health.

PURPOSE: This study investigated the role of mothers in their preadolescents' oral self-care (OSC) and oral health in Tehran, Iran. MATERIALS AND METHODS: In 2005, two self-administered questionnaires provided data on a random sample of 9-year-old children (N = 416) and their mothers. Brushing frequency, use of fluoridated dentifrice and the number of sugary snacks between meals served as OSC assessment criteria for both children and their mothers. Supervision of the child's tooth brushing and control of the child's sugary snacking indicated the mother's role that was defined as either active or inactive. Decayed, missing or filled teeth (DMFT + dmft) values facilitated the assessment of children's dental status in a voluntary clinical examination for children. The child's twice-daily tooth brushing, sound dentition and good oral hygiene were taken as the outcome measures for evaluating the impact of the mother's role. The chi-square test and logistic regression model were used for the analyses. RESULTS: Half of the mothers were assessed as active in the supervision of their children's tooth brushing. Supervision was clearly more frequently reported by the mothers whose own OSC was favourable. In the logistic regression model, the strongest factors contributing to the explanation of twice-daily tooth brushing were the child's female gender (odds ratio, OR = 1.6; 95% confidence interval, 95% CI = 1.1 to 2.4) and the mother's active supervision (OR = 1.5; 95% CI = 1.0 to 2.2). Having sound dentition was most strongly explained by the mothers' active supervision of their children's tooth brushing (OR = 2.4; 95% CI = 1.3 to 4.5). CONCLUSIONS: The mothers' supporting role positively reflects on twice-daily tooth brushing and sound dentition in preadolescents. More preventive efforts through mothers should be considered during the planning of promotion programmes for preadolescents.