The development and application of a risk prediction model for dental caries in primary schoolchildren in Flanders

In dit proefschrift, ‘de ontwikkeling en toepassing van een cariës risico model bij lagere schoolkinderen in Vlaanderen’ wordt mondgezondheidszorg gekaderd in een streven naar algemeen welzijn. Het begrip ‘gezondheid’ wordt gezien in zijn ‘holistische’ betekenis, namelijk een toestand van een totaal welzijn, zowel op fysisch, mentaal als sociaal vlak. Het accent ligt evenwel op mondgezondheidszorg bij kinderen en is gefocust op cariës. Ondersteund door het gezondheidspromotie concept van de Wereld Gezondheid Organisatie, wil dit onderzoek zich niet beperken tot een individualistische benadering van het cariës probleem bij kinderen. Cariësvoorkomen en risicogedrag zijn niet enkel een zaak van vrije keuze en individuele verantwoordelijkheid, maar worden veeleer beschouwd als resultaat van een breed gamma socio-structurele factoren

Socioeconomic inequalities in caries experience, care level and dental attendance in primary school children in Belgium : a cross-sectional survey

Objectives: Oral health inequality in children is a widespread and well-documented problem in oral healthcare. However, objective and reliable methods to determine these inequalities in all oral health aspects, including both dental attendance and oral health, are rather scarce. Aims: To explore oral health inequalities and to assess the impact of socioeconomic factors on oral health, oral health behaviour and dental compliance of primary school children. Methods: Data collection was executed in 2014 within a sample of 2216 children in 105 primary schools in Flanders, by means of an oral examination and a validated questionnaire. Intermutual Agency database was consulted to objectively determine individuals' social state and frequency of utilisation of oral healthcare services. Underprivileged children were compared with more fortunate children for their mean DMFt, DMFs, plaque index, care index (C, restorative index (RI), treatment index (TI), knowledge and attitude. Differences in proportions for dichotomous variables (RI100%, TI100% and being a regular dental attender) were analysed. The present study was approved by the Ethics Committee of the University Hospital Ghent (2010/061). All parents signed an informed consent form prior to data collection. All schools received information about the study protocol and agreed to participate. Children requiring dental treatment or periodic recall were referred to the local dentist. Results: Underprivileged children had higher D1MFT (95% CI 0.87 to 1.36), D3MT (95% CI 0.30 to 0.64), plaque scores (95% CI 0.12 to 0.23) and lower care level (p< 0.02). In the low- income group, 78.4% was caries-free, compared with 88.4% for the other children. Half of the low- income children could be considered as regular dental attenders, while 12.6% did not have any dental visit during a 5-year period. Conclusion: Oral health, oral hygiene, oral healthcare level and dental attendance patterns are negatively affected by children's social class, leading to oral health inequalities in Belgian primary school children

Caries experience and gingivitis levels of permanent first molars in relation to timing of emergence

Aims: The present study examined the prevalence of dental caries in and gingivitis around permanent first molars (PFM) in relation to their timing of emergence. Methods: In a group of 1609 “early emergers” (all PFM present at baseline) and a group of 336 “late emergers” (no PFM present at baseline), caries experience, the presence of plaque, and gingival health were evaluated annually during five follow-up examinations. Results: Even though all children were born in the same year, mean DMFS scores for PFM remained higher in the early emergers throughout the study; mean buccal plaque and gingivitis scores were comparable in both subgroups. Early emergers had a significantly increased risk of caries experience in the occlusal surface of the PFM for two to four years. No consistent association was observed between timing of emergence and gingivitis levels. Conclusions: It is recommended that dental age as well as chronological age should be taken into account when caries prevalence data in young children are compared

Social gradient in caries experience of Belgian adults 2010

Objective: This study aims to explore the caries experience of the Belgian population in relation to social indicators. Basic research design: Data collection (2009-2010) consisted of an oral health questionnaire and examination during a home visit. Participants: Representative sample of the Belgian population (>5 years old). Only the economically active population was included for final analyses. Main outcome measures: ANOVA and multivariable regression analyses were used to reveal associations between social indicators, oral hygiene, untreated decay, DMFT and edentulousness. Results: 2742 participants completed the questionnaire, of whom 2563 were examined clinically. Most (53%) were female and mean age was 43.3 years (95% CI= 41.2-45.4). In the total population, 11.1 % were caries-free (DMFT = 0) and mean DMFT was 10.8 (95% CI = 10.0-11.5). In the analysed subsample, higher educated participants had lower DMFT scores than those with low or no educational qualifications (p = 0.003). Employment status was associated with the presence of untreated tooth decay, especially in the youngest age group (p = 0.015), and with edentulousness (p = 0.02), with a higher risk among unemployed women of being completely edentulous (OR = 5.32; 95% CI = 1.75-16.12). Untreated tooth decay was related to frequency of tooth brushing and plaque index (p < 0.002 and < 0.001 respectively). Conclusions: Caries experience in Belgium, expressed as mean DMFT and proportion of untreated tooth decay, is more associated with level of education and employment status than with family income, which is still the main criterion for larger government allowances for healthcare in Belgium

The impact of a preventive and curative oral healthcare program on the prevalence and incidence of oral health problems in nursing home residents

Aims: To assess the impact of an oral healthcare program in nursing homes on the initial treatment backlog and residents' oral health stability. Materials and methods: The study is a longitudinal cohort study in nursing home residents in Flanders, Belgium, to evaluate the oral healthcare programme Gerodent. The program consisted of: (1) the introduction of an oral healthcare team, (2) oral health education, (3) the implementation of oral health guidelines and protocols, and (4) regular visits of a mobile dental team. Data were extracted from the oral health records of 381 residents from 21 nursing homes who received treatments from the mobile dental team between October 2010 and March 2014 (mean follow-up period of 22.5 months). Oral health and treatment need between baseline and follow-up were compared. Results: The mean age at baseline was 82.4 years and the mean number of consultations per resident was 3.61 during the follow-up period. The proportion of residents with an oral treatment need was reduced from 65.9% to 31.3%. Among residents with natural teeth, there was significantly lower prevalence of caries (from 70.5% at baseline to 36.5% at follow-up; p<0.001), residual roots (from 54.2% to 25.1%; p<0.001), and need for fillings (from 31.9% to 17.1%; p<0.001) or extractions (from 64.3% to 31.6%; p<0.001). In the group with partial or full dentures (n = 223), 38.1% needed a repair, rebasing or renewal of their existing dentures at baseline and the respective figure at follow-up was 9.0% (p<0.001). In terms of oral health stability, 53% of the residents had no incident restorative and prosthetic treatment need throughout the follow-up period. A lower number of natural teeth at baseline (p<0.001) and a shorter follow-up period (p = 0.002) were associated with higher chances of oral health stability. Conclusion: The oral healthcare program Gerodent significantly reduced the treatment backlog and contributed to a considerable proportion of residents being stable in terms of oral health without any incident treatment needs

An expert opinion from the European College of Gerodontology and the European Geriatric Medicine Society : European policy recommendations on oral health in older adults

This is an expert opinion paper on oral health policy recommendations for older adults in Europe, with particular focus on frail and care-dependent persons, that the European College of Gerodontology (ECG) and the European Geriatric Medicine Society (EUGMS) Task and Finish Group on Gerodontology has developed. Oral health in older adults is often poor. Common oral diseases such as caries, periodontal disease, denture-related conditions, hyposalivation, and oral pre- and cancerous conditions may lead to tooth loss, pain, local and systemic infection, impaired oral function, and poor quality of life. Although the majority of oral diseases can be prevented or treated, oral problems in older adults remain prevalent and largely underdiagnosed, because frail persons often do not receive routine dental care, due to a number of barriers and misconceptions. These hindrances include person-related issues, lack of professional support, and lack of effective oral health policies. Three major areas for action are identified: education for healthcare providers, health policy action plans, and citizen empowerment and involvement. A list of defined competencies in geriatric oral health for non-dental healthcare providers is suggested, as well as an oral health promotion and disease prevention protocol for residents in institutional settings. Oral health assessment should be incorporated into general health assessments, oral health care should be integrated into public healthcare coverage, and access to dental care should be ensured