Application of the extended theory of planned behavior to predict dentist intention and behavior in providing caries preventive care for preschool children.

BACKGROUND: Various studies show a gap between evidence-based recommendations and the preventive practice of dentists. This study aimed to create and assess an extended Theory of Planned Behavior (TPB) model on dentists' intentions to do caries preventive measures and related barriers experienced by dentists. METHODS: A total of 362 general dentists from 34 Indonesian provinces were included in this study. A self-administered online questionnaire consisted of three sections: dentist characteristics and practice pattern, TPB questionnaire, and dentist perceived behavior regarding preventive care for pediatric patients. The questionnaire was distributed and the data was analyzed through structural equation modeling. RESULTS: TPB's extended version is a fit and relevant model, explaining 55.3% of dentists' intentions to undertake preventive procedures and 17.8% of preventive practices. Perceived behavioral control was the most powerful predictor of intention (44.2%) and practice (8.8%), while parental barriers were the most significant barrier to provide preventive care (18.9%). CONCLUSION: Extending the TPB by taking barriers from multiple stakeholders as a consideration has a higher predictive level for preventive practices. Each barrier should be addressed through oral health programs and policies, and dentists must be taught to overcome these barriers (through formal or continuing education) in order to maximize caries prevention strategies.

Perceived Barriers among Indonesian General Dentists in Providing Caries Preventive Care for Pediatric Patients.

OBJECTIVE: This study aimed to investigate Indonesian dentists' perceived barriers in providing caries prevention for pediatric patients. MATERIALS AND METHODS: A total of 362 general dentists were included in this cross-sectional study. The participants were asked to complete a self-administered online questionnaire of dentist characteristics and perceived barriers in multiple domains (children, parents, dentists, and healthcare system-related barriers). The frequency of responses to items of the questionnaire was presented. The Mann-Whitney U test was used to compare perceived barriers by gender, Kruskal-Wallis by practice sector, and Spearman analysis was used to assess the correlation between perceived barrier with age, years of practice experience, weekly practice hours, percentage of pediatric patients, percentage of pediatric preventive care, and percentage of insured patients. A multivariate analysis was conducted through structural equation modeling. RESULTS: The highest perceived barrier was found to be healthcare system-related, followed by parents, children, and dentists themselves. Most participants thought parents have poor knowledge of pediatric caries prevention (n = 290; 80%), and dental care for young children emphasizes curative treatment over prevention (n = 257; 70%). The multivariate analysis showed that dentists' practice sector and age affect perceived barriers and pediatric preventive care the most. CONCLUSIONS: Factors and barriers identified in this study must be the main focus of oral health programs, and dentists, as service providers, need proper training to address these barriers to optimize caries prevention in Indonesia.

Validity of mother-child self-perceived oral health for the assessment of 5 years old children's oral health in Indonesia.

BACKGROUND: Early childhood caries (ECC) is a serious condition that has a negative impact on young children's quality of life. Mothers' perceived need for oral health care plays an important role in their children's oral health behavior. This study aimed to compare mother and child self-perceived and dentist-evaluated needs for oral health care. METHODS: This cross-sectional study included 266 preschool children aged 5 years old and their mothers. A self-administered questionnaire to the mothers and interviews with the children were used to assess the perceived needs of oral health care. The mothers were asked to rate their children's oral health and determine if they needed dental treatment. The children were also asked how they felt about their oral health and whether they had any tooth decay. Agreement between mother and child regarding the child's oral health was assessed. The evaluated needs were assessed clinically using the dmft (decayed, missing, and filled teeth [primary dentition]) and pufa (pulpal involvement, ulceration, fistula, and abscess [primary dentition]) indices. The perceived and evaluated needs were compared using spearman analysis to determine their correlations and the validity of the perceived needs compared to the clinical examination was assessed using the area under the curve (AUC), sensitivity (Sn), specificity (Sp), and likelihood ratio (LR). RESULTS: The prevalence rate of ECC was 89.4%, with 35% having at least one condition from untreated caries (pufa > 0). Mothers and children have a fair agreement regarding the child's oral health (ICC = 0.335). When comparisons were conducted between perceived and evaluated conditions, Mother's rating about their child's oral health showed the strongest correlation to dmft index (r = 0.372; p < 0.001). Several accuracy parameters done in this study (AUC, Sn, and Sp) did not meet the acceptable threshold. The sensitivity and specificity were the highest when comparing mothers' perceived need for their child's dental treatment to the dmft index (Sn = 96.7%) and pufa index (Sp = 88.1%), respectively. CONCLUSION: Compared to the dentist's assessment, the mother and child self-reported oral health statuses showed lower accuracy in assessing the child's condition. But, the mothers in this study were better than their 5-year-old children at perceiving their child's oral health care needs. As a result, these subjective assessments can be used as a complement, but not as a substitute, to the actual clinical evaluation.

The Relationships Among Oral Health Practices, Early Childhood Caries, and Oral Health-related Quality of Life in Indonesian Preschool Children: A Cross-Sectional Study.

OBJECTIVES: This study aimed at evaluating the relationships among oral health practices, early childhood caries (ECC), and oral health-related quality of life (OHRQoL) in five-year-old children in Indonesia. MATERIALS AND METHODS: Overall, 266 parent-child pairs (PCPs) from preschools in Jakarta participated in a cross-sectional study. The ECC was clinically assessed by two calibrated screeners using the decayed, missing, and filled teeth (dmft) and the pufa index, which records the presence of severely decayed teeth with visible pulpal involvement (p), ulceration caused by dislocated tooth fragments (u), fistula (f), and abscess (a). The parents of the participating children completed the self-administered questionnaire comprising SOHO-5p and their oral health practices. The SOHO-5c questionnaire was used to interview the children. RESULTS: The prevalence of ECC was 88.7%, with 35% having pufa index scores greater than 0. There were significant relationships among oral health practices, ECC, and the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5) scores. There was also a significant relationship between cariogenic food consumption and the dmft and SOHO-5p scores. There was a significant relationship between ECC and the SOHO-5 scores. All the SOHO-5p variables except smile avoidance because of appearance had a significant relationship with the dmft and pufa variables. Eating and sleeping difficulties were significantly related to the dmft and pufa scores. CONCLUSION: OHRQoL was found to be related to the dmft and pufa scores, and the parents' perceptions were more strongly correlated than the children's. No significant difference was found in the perceptions indicated by the SOHO-5p and SOHO-5c scores. This suggests that parents can be used as proxies regarding their children's OHRQoL.