impact of oral health education on oral health status

Impact of oral health education on oral health status

School based oral health education ‐School based oral health education ‐programprogram

Ghada Elmasuri 28-05-2014

Section 1: About oral health Section 2:The prevalence and trends of oral diseases Section 3: Inequalities relating to oral diseases treatment Section 4: School based oral health education Section 5: Effectiveness Section 6: Understanding the problems Section 7: Conclusions and Recommendations

Slides numbers: 50Estimated time: 30 minutes

In 1948 the World Health Organization defined oral health as “a complete state of physical, mental, and social well-being, and not just the absence of infirmity.”

World Health Organization (WHO). Constitution of the World Health Organization. Geneva: WHO Basic Documents; 1948.

Physical well–being assumes the ability to function normally in activities such as speaking, eating, and moving around.

Mental well–being implies that there is no burden of fear, anxiety, stress, depression, or other negative emotions.

Social wellbeing relates to one’s ability to participate in society, fulfilling roles and duties.


Oral health is fundamental to overall health, wellbeing and quality of life. A healthy mouth enables people to eat, speak, work and socialize without pain, discomfort or embarrassment.

Healthy Mouths, Healthy Lives: Australia’s National Oral Health Plan 2004–13 (2004). Prepared by the National Advisory Committee on Oral Health.

“The mouth is the gateway to the rest of the body, a mirror of our overall well-being.”Along this, oral health must be perceived as a critical component of general health.

Harold C. Slavkin, D.D.S. Former Director of the National Institute of Dental and Craniofacial Research, and Dean of the University of Southern California School of Dentistry

Dental disease negatively impacts general quality of life, affecting not only physical wellbeing but also psychological and social wellbeing.


Source: self constructed. Adapted definition of oral health by WHO 1948

Directly associated with deteriorating diet and compromised nutrition

Locker 1992 Further, the mouth is often an entry point for infections, which may spread to other parts of the body.

US Department of Health and Human Services (2000)

Locker, D. (1992), ‘The burden of oral health in a population of older adults’, Community Dental Health, June; 9(2), pp.109–24.

US Department of Health and Human Services (2000), Oral health in America: A report of the Surgeon General, Rockville, MD: US Department of Health and Human Services,

A person whose appearance and speech are impaired by dental disease can experience anxiety, depression, poor self–esteem and social stigma which in turn may inhibit opportunities for education, employment and alter the ability to sustain and build social relationships”.

Ibid, p.137.

Oral health problems can affect a person's ability to maintain a job or get promotions. They can also contribute to lowered academic achievement and goals. These effects have increased when a deformity due to the oral health condition is involved

Hollister & Weintraub, 1993; Reisine, 1989

Children face the additional challenge of poor oral health far reaching effects into their adulthood. Dental conditions in childhood can restrict children’s participation in schooling and education through days lost to illness. Impaired physical appearance due to dental disease can further limit children’s ability to socialize with confidence and develop social norms and relationships.

Tooth decay is the most common chronic childhood disease affecting 60 90% of school children.‑

It is over five times more prevalent than asthma among children.

7 times more common than hay fever. 52 million school hours missed annually because of oral problems

National Institute of Dental and Craniofacial Research. (2001, Feb).

Global oral health data bank. Geneva: World Health Organization; 2004.

.

There are profound inequalities in caries status, between countries, and that the distribution of disease in a population is a changing dynamic.

Marmot, M. and Wilkinson, R. (1999), Social determinants of health, Oxford University Press, Oxford.

Health inequalities are the systematic, structural differences in health status between and within social groups within the population.

The term ‘‘health inequalities’’ is closely linked to ‘‘social determinants of health’’.

Lack of income, schools, and education, inappropriate housing, unsafe workplaces and lack of access to health care systems are some of the social determinants of health leading to inequalities.

Source: Social Determinants of Health, The Solid Facts. World Health Organization, 2003

Health inequalities can be seen as an outcome of Social Inequalities

Source: Social Determinants of Health, The Solid Facts. World Health Organization, 2003

Studies showed Children from a deprived background may have five time more tooth decay than children from more affluent backgrounds.

National Alliance for Equity in Dental Health, 2004

“One of the suggested strategy for reaching disadvantaged children is by providing school-based oral and dental health services …

Grant Makers in Health Issue Dialogue.. (2001, May). Filling the Gap: Strategies for Improving Oral Health. Issue Brief.

The World Health Organization advocates using Health Promoting Schools programs to promote general and oral health.

Oral health education is a key component in any School Oral Health Program.

Kwan SY, Petersen PE, Pine CM, Borutta A. 2005, Health-promoting schools: an opportunity for oral health promotion, Bulletin of the World Health Organization, vol. 83, pp. 677-685.

“ You cannot educate a child who is not healthy, and you cannot keep a child healthy who is not educated.”

Jocelyn Elders, Former US Surgeon General

Health education is any combination of learning experiences designed to facilitate voluntary actions conducive to health.

Integration of oral health into the school curriculum

In recent years, attention has been drawn toward assessing the effectiveness of oral health education programs. This is in line with demand for evidence based research and will help to inform policy makers on how to allocate resources.

Evidence based papersEvidence based papers

Google, Google Scholar, the Cochrane Library MEDLINE and EMBASE electronic databases were searched as well as hand searching of found references and review articles.

The strength of the evidence to support each intervention is indicated using the modified Davies et al 2003 hierarchy:

Type 1 Systematic review Type 2 At least one RCT Type 3 Non-randomised intervention studies Type 4 Observational studies.

Davies R M, Davies G M, Ellwood R P, Kay E J. Prevention. Part 4: Toothbrushing: What advice should be given to patients? Br Dent J 2003; 195: 135-141.

Derek Richards. Centre for Evidence-based Dentistry, Oxford, UK. Evidence-Based Dentistry (2013) 14, 42-43. doi:10.1038/sj.ebd.6400929

Effectiveness of oral health promotion. Health promotion effectiveness reviews Summary bulletin 7 – 1997 ISBN 0 7521 1039 X

Authors Objective Strength of evidence

Findings

Kay and Locker 1997

to assess the effectiveness of school oral health interventions designed to reduce dental caries

Type 1systematic review of 94 scientific journals,published between 1984 and 1997.

There is no evidence in the literature that school oral health education alone effects caries rates, even if changes in behavior are achieved, unlessfluoride is being used.


Findings

Khan et al., 2013

to identify effectiveness of school oral hygiene instructions

Type 1systematic review of studiespublished between 1990 and 2013.

School oral health activities have a great impact for the improvement of oral health knowledge among children However, there is no evidence thatchanges in knowledge are causally related to changes in behavior.


Findings

Cooper et al., 2013

To assess the clinical effects of school-based interventions aimed at changing behavior related to tooth brushing habits and the frequencyof consumption of cariogenic food and drink in children (4 to 12 year olds) for caries prevention.

Type 1systematic review of studiespublished between 1950 to 2012.

Currently, there is insufficient evidence for the efficacy of primary school-based behavioral interventions for reducing caries. There islimited evidence for the effectiveness of these interventions on plaque outcomes and on children’s oral health knowledge gain.

Cooper AM, O’Malley LA, Elison SN, Armstrong R, Burnside G, Adair P, Dugdill L, Pine C. Primary school-based behavioural interventions for preventing caries. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD009378. DOI: 10.1002/14651858.CD009378.pub2.

Poul Erik Petersen, Bin Peng, Baojun Tai, Zhuan Bian and Mingwen FanEffect of a school-based oral health education programme in Wuhan City, Peoples Republic of China Int Dent J 54:33-41. 2004

Ajithkrishnan CG, Thanveer K, Sudheer H, Abhishek S. Impact of oral health education on oral health of 12 and 15 year old schoolchildren of Vadodra city, Gujarat state. J Int Oral Health. 2010;2:15-20.

Authors Study Area -population

Type of Intervention

Plaque/Gingival Scores

Dental Caries

Knowledge, Attitude & Practice

Petersen et al., 2004

China- primary school children

Type 3“3 years experimental trail based on WHO OHE program

Positive effects on gingival bleedingscore

No effect on dental cariesPrevention was observed

positive effects

Ajithkrishnan et al., 2010

India- 12-15 year

Type 3“3 months clinical trails”

Reduced plaque score but no reduction in gingival scores

No reduction in DMFT scores

-

A number of systematic reviews have been conducted on the available evidence for the effectiveness of school-based

behavioral interventions . These have shown that oral health education can be effective in increasing knowledge in the short term and to some extent, behavior such as tooth brushing and healthy eating. However there is a limited

evidence for its effectiveness on children’s oral health in terms of reducing dental plaque and dental caries.

Comments about the findings

Oral diseases are multifactorial.

Dahlgren and Whitehead, 1993

Dahlgren G, Whitehead M (1993). Tackling inequalities in health: what can we learn from what has been tried? Working paper prepared for the King’s Fund

The Ottawa Charter defines health promotion as ‘the

process of enabling people to increase control over,

and to improve, their health’.

The Ottawa Charter for Health Promotion. First International Conference on Health Promotion, Ottawa, 21 November 1986

Basic logic: Can school-based interventions aimed at improving health status

works?.........

Health education interventions are of limited value and should be supported by a full range of health promotion

approaches.Multiple interventions that complement and reinforce each

other, and involve a range of community partners and stakeholders may be more effective than single

interventions.

Link to the home by actively involve parents in school interventions Provide support for teachers or use non-teacher supervisors Employ oral health professionals to provide support for Health

Promoting Schools approaches, rather than only provide classroom lessons

Involve private dental providers in planning for greater cooperation

Integration with other health issues enhances the likelihood of sustainability.

Long-term school support is needed.

Simpson in 2011 provides a promising multi-stage model based on four stages: training, adoption, implementation and practice improvement, along with sustaining influences involving preparation and maintenance.

Simpson DD. Implementing sustainable oral health behavioral and social interventions. J Public Health Dent. 2011; 71:S84–S94.

Address the broader determinants of health.

Focusing on these determinants is the key

to preventing disease and to propose strategies for overcoming inequalities in

oral health.

Iceberg phenomenon Ernest Hemingway 1923

Individual Factors

Environmental conditionsWater fluoridationRestricting marketing and improving labelling of food products

Social EnvironmentMarketing healthy behavior influencing social and family norms that link to oral health knowledge, attitudes, beliefs, values.

Improve education and awareness Reduce barriers to health care seeking

practices

Governments have a responsibility for the health of their citizen to lead a socially and economically productive life.

Combined efforts

impact of oral health education on oral health status

Healthcare