The prevalence of Early Childhood Caries in 1-2 yrs olds in a semi-urban area of Sri Lanka

<p>Abstract</p> <p>Background</p> <p>ECC remains a problem in both developed and developing countries and ECC has been considered to be present in epidemic proportions in the developing countries. The aetiology and associated factors of ECC should be studied adequately to overcome this health hazard. The objective of this study is to determine the prevalence of ECC in 1 to 2 years old children in some selected MOH areas (semi-urban) in the district of Colombo, Sri Lanka.</p> <p>Methods</p> <p>This study was conducted as a cross sectional study. A total of 422 children aged 1-2 years were selected using systematic sampling technique in Maharagama, Piliyandala, Nugegoda and Boralesgamuwa MOH areas in Colombo district, Western province, Sri Lanka. The pre-test was done initially with 10 children aged 1 1/2 year olds.</p> <p>Prior to the clinical examination of each child, a questionnaire consisting questions regarding tooth brushing, dietary habits, breast and bottle feeding, long term medications(Sweetened medications taken more than 3 months), attending a dental clinic during pregnancy of mother and socio-economical status of the family was administered to mothers of those children. Sterile dental mouth mirrors were used to detect ECC in children.</p> <p>Results</p> <p>The prevalence of ECC of the whole sample of 410 children aged 1-2 years was 32.19% and the mean dmft was 2.01 and the mean dmfs was 3.83. From the children who had ECC 95% were untreated. There were significant relationships between dmft and long term use of medications (p < 0.000), intake of sugar with milk (p = 0.013), sweet consumption (p = 0.013), employment of mothers (p < 0.000) and visiting a dental clinic during pregnancy (p < 0.000).</p> <p>Conclusions</p> <p>This study documents high prevalence and severity of ECC among 1-2 years old children in four selected MOH areas of Colombo district and caries in most of the children with ECC (95%) were untreated. Results reveal an urgent need to increase awareness among the public about ECC and institute preventive strategies.</p

Effectiveness, cost-effectiveness and cost-benefit of a single annual professional intervention for the prevention of childhood dental caries in a remote rural Indigenous community

Background The aim of the study is to reduce the high prevalence of tooth decay in children in a remote, rural Indigenous community in Australia, by application of a single annual dental preventive intervention. The study seeks to (1) assess the effectiveness of an annual oral health preventive intervention in slowing the incidence of dental caries in children in this community, (2) identify the mediating role of known risk factors for dental caries and (3) assess the cost-effectiveness and cost-benefit of the intervention. Methods/design The intervention is novel in that most dental preventive interventions require regular re-application, which is not possible in resource constrained communities. While tooth decay is preventable, self-care and healthy habits are lacking in these communities, placing more emphasis on health services to deliver an effective dental preventive intervention. Importantly, the study will assess cost-benefit and cost-effectiveness for broader implementation across similar communities in Australia and internationally. Discussion There is an urgent need to reduce the burden of dental decay in these communities, by implementing effective, cost-effective, feasible and sustainable dental prevention programs. Expected outcomes of this study include improved oral and general health of children within the community; an understanding of the costs associated with the intervention provided, and its comparison with the costs of allowing new lesions to develop, with associated treatment costs. Findings should be generalisable to similar communities around the world. The research is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), registration number ACTRN12615000693527; date of registration: 3rd July 2015

Pediatric quality of life instruments in oral health research: A systematic review

Objective: To identify the generic or disease-specific pediatric quality of life (QoL) instruments used in oral health research among children and adolescents and to provide an overview of these QoL instruments. Methods: A systematic literature search was performed with multiple databases to identify the pediatric QoL instruments used in oral health research. Results: The literature search yielded 872 records; from these, 16 pediatric QoL instruments were identified that had been used among children and adolescents in oral health research. Of these, 11 were oral health–specific QoL instruments and five were generic instruments. Of the 11 oral health–specific QoL instruments, none were multiattribute utility instruments (MAUI), whereas of the five generic instruments, two (Child Health Utility 9D index and EuroQoL-5D youth) were classified as an MAUI. Except for one, all pediatric QoL instruments were published after the year 2000 and the majority originated from the USA (n = 8). Of the 11 oral health–specific QoL instruments, five instruments are designed for the respondent to be a child (i.e., self-report), one uses proxy responses from a parent or guardian, and five instruments have both self and proxy versions. Of the five generic QoL instruments, one uses proxy responses and the other four instruments have both self and proxy versions. Conclusions: This review identified a wide variety of pediatric oral health–specific and generic QoL instruments used in oral health research among children and adolescents. The availability of these QoL instruments provides researchers with the opportunity to select the instrument most suited to address their research question.</p

Burden of invasive pneumococcal disease (IPD) in Sri-Lanka: Deriving a reasonable measure for vaccine introduction decision making

Purpose The lack of evidence on the disease burden has been an obstacle for decision-making on introducing pneumococcal vaccines in Sri-Lanka. Hence, the purpose of this study is to determine the incidence of invasive pneumococcal disease among children under five-years of age in Sri-Lanka's Colombo district. Methods In a community-based study, using a sample of 2310 children, we identified syndromes associated with pneumococcal disease (pneumonia, meningitis, sepsis). The estimates of annual cumulative incidence of invasive pneumococcal disease were derived by having applied proportions of laboratory confirmed invasive pneumococcal disease among all-cause syndromes associated with pneumococcal infection obtained from the hospital-based invasive bacterial disease sentinel surveillance and findings of the community-based study to population parameters of the district. The estimates of invasive pneumococcal pneumonia and sepsis based on low-sensitive, culture confirmation were adjusted by a correction factor. Results The annual cumulative incidence of all-cause clinical syndromes associated with pneumococcal disease (pneumonia, meningitis, sepsis) were 1.3, 0.52, 0.39 per 100 children, respectively. The estimate of adjusted, invasive pneumococcal disease cumulative incidence was 206.3 per 100,000 while estimates of pneumococcal pneumonia, meningitis and sepsis cumulative incidence were 147.9, 13.2 and 45.2 per 100,000 under-five children. Conclusion Reasonable estimates of invasive pneumococcal disease could be derived by using incidence of clinical syndromes associated with pneumococcal disease obtained from population-based studies and proportion of pneumococcal infection among all-cause clinical syndromes associated with pneumococcal disease generated from hospital-based sentinel surveillance. These estimates may help informed decision-making on introduction of pneumococcal conjugated vaccine

An analysis of rate and factors affecting malignant transformation of oral submucous fibrosis in patients attending the Oral Medicine Clinic, Dental Hospital Peradeniya, Sri Lanka - A retrospective study

Background: Oral submucous fibrosis (OSF) is a chronic, progressive, scarring and potentially malignant disease of the oral mucosa seen primarily in the Indian subcontinent and in South East Asia. OSF is a premalignant condition with a malignant transformation rate varying from 7-12%. Even though OSF and oral cancer are common in Sri Lanka, malignant transformation potential and rate have not been studied in our population. Objectives: To identify the relationship of malignant transformation with age, gender, habits, amount of mouth opening, duration of follow up, presence of other oral potentially malignant disorders and dysplasia in a group of patients with OSF attending the Oral Medicine clinic, University Dental Hospital Peradeniya. Methods: All the clinical files of patients with OSF attending the Oral Medicine clinic, University Dental Hospital Peradeniya were selected. Cases with OSF where histopathological diagnosis was not available, patients who had developed oral cancer before the diagnosis of OSF and patients who were diagnosed with OSF and received prior surgical therapy were excluded. Data were analysed to identify any relationship of malignant transformation with other variables. Results: There were 135 patients with a follow up period ranging from 6 months to 23 years and average follow up period was 5.26 years. 75.6% of them were males. 42.2% of them presented with burning sensation as the main complaint. 96.3% of them chewed betel with all ingredients whereas the rest chewed only arecanut. Eight patients developed malignancy during the follow up period giving a malignant transformation rate of 5.9% after a mean follow up period of 6.5 years. Conclusions: Malignant transformation in patients with OSF is significantly associated with presence of dysplasia on the initial biopsy, presence of any other potentially malignant disorder and the duration of betel chewing

Digital health solutions for reducing the impact of non-attendance: A scoping review

Objectives: Non-attendance is a significant source of waste in contemporary healthcare systems and can contribute to lengthened waiting lists, and limited appointment accessibility for patients. This scoping review aimed to systematically examine the scope of evidence regarding digital health interventions that have the potential to reduce the impact of non-attendance at scheduled outpatient appointments. Methods: Four databases were searched from 01 January 2010 to 15 February 2023. This review included studies that report on implementing one or more digital solutions to reduce the impact of non-attendance in the outpatient setting. Data was extracted on whether the implementation of the digital solution led to a reduction in non-attendance or improvement in a non-attendance metric, as well as the reported costs and cost-effectiveness of solutions where available. Results: Of the total of 3,730 records, 55 articles were included in the analysis. These papers reported on automated reminder systems (n=24), prediction models coupled with a targeted intervention (n=4), telehealth (n=21) and booking systems (n=6). The effectiveness of the digital health-related solution was seen across several studies: 12 reminder systems, 3 prediction models, 14 telehealth, and 6 booking systems. Only nine studies reported costs and one study reported cost-effectiveness. Conclusions: While reminder systems were the most commonly investigated intervention in the field, there is emerging evidence to support other digital health-related solutions that have the potential to reduce the impact of non-attendance across outpatient healthcare settings. Further investigations of these emergent technologies, including economic evaluations, are needed to provide appropriate policy and practice guidance. Public interest summary: Non-attendance (situations where a patient fails to attend scheduled appointments at the specified time without advanced cancellation or rescheduling) is considered a significant source of resource waste in healthcare systems. Several strategies have been trialled with varying degrees of success to address non-attendance, with some strategies being cost-inefficient, labour intensive, and resulting in poor patient experience. Digital health technologies are evolving at a rapid pace and providing new opportunities to reduce the impact of non-attendance at scheduled appointments. This review identifies digital health solutions for reducing the impact of non-attendance described in literature, research evidence on the effectiveness of these solutions, and the extent to which costs and cost-effectiveness of these solutions have been examined and reported. The study highlights the potential for emergent technologies to be used to reduce the impact of non-attendance and the need for further investigations to provide appropriate policy and practice guidance.</p

A scoping review of cost‐effectiveness analyses of school‐based interventions for caries

Objectives The aims of this study were to: identify the evidence on cost‐effectiveness of school‐based interventions for caries prevention globally up to 2019; summarize key characteristics of interventions applied within this setting; summarize the reporting quality of previous studies; and to identify and analyse knowledge gaps.Methods A scoping review of published literature on the cost‐effectiveness of school‐based interventions to prevent child tooth decay was conducted. A search in Medline, Cinahl and Embase was performed with no date restriction. Reporting quality of the included studies was assessed against Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist.Results Of the 738 records identified in the initial search, 15 studies met the pre‐specified inclusion criteria. The majority were published after 2011 (n = 9,) and applied to high‐income countries (n = 12). Nearly 80% of the studies assessed the cost‐effectiveness of the interventions based on topical fluoride therapies and fissure sealants at school premises. Although, the outcome measures differed across the studies, almost all the caries preventive interventions were cost‐saving or cost‐effective when compared with usual care. Compliance with the CHEERS checklist differed.Conclusions There is evidence to suggest that school‐based caries preventive interventions are cost‐effective, and in some cases cost‐saving. Further evidence is required from low‐ to middle‐income countries to confirm the generalizability of these findings. Future studies should consider adopting Quality Adjusted Life Years as a generic outcome measure that would enable the cost‐effectiveness findings to be compared across different types of interventions and diseases. Improved standardization and quality of reporting are also required

Consumer Preferences for a Healthcare Appointment Reminder in Australia: A Discrete Choice Experiment

Background: It is essential to consider the evidence of consumer preferences and their specific needs when determining which strategies to use to improve patient attendance at scheduled healthcare appointments. Objectives: This study aimed to identify key attributes and elicit healthcare consumer preferences for a healthcare appointment reminder system. Methods: A discrete choice experiment was conducted in a general Australian population sample. The respondents were asked to choose between three options: their preferred reminder (A or B) or a ‘neither’ option. Attributes were developed through a literature review and an expert panel discussion. Reminder options were defined by four attributes: modality, timing, content and interactivity. Multinomial logit and mixed multinomial logit models were estimated to approximate individual preferences for these attributes. A scenario analysis was performed to estimate the likelihood of choosing different reminder systems. Results: Respondents (n = 361) indicated a significant preference for an appointment reminder to be delivered via a text message (β = 2.42, p < 0.001) less than 3 days before the appointment (β = 0.99, p < 0.001), with basic details including the appointment cost (β = 0.13, p < 0.10), and where there is the ability to cancel or modify the appointment (β = 1.36, p < 0.001). A scenario analysis showed that the likelihood of choosing an appointment reminder system with these characteristics would be 97%. Conclusions: Our findings provide evidence on how healthcare consumers trade-off between different characteristics of reminder systems, which may be valuable to inform current or future systems. Future studies may focus on exploring the effectiveness of using patient-preferred reminders alongside other mitigation strategies used by providers.</p

Development of a classification (descriptive) system for a preference-based quality of life measure for dental caries (dental caries utility index) among adolescents

Objectives: Preference-based quality-of-life measures (PBMs) have been developed in many clinical areas to aid estimation of more accurate utility values for economic evaluations. Existing oral health-related quality-of-life (OHRQoL) instruments are non-PBM and hence, cannot be used to generate utility values. The objective of this study was to develop a classification system for a new PBM (dental caries utility index-DCUI) for the most prevalent childhood oral health condition: dental caries. Methods: Possible domains and items to be included in the classification system were identified based on the reviewing available pediatric non-PBM OHRQoL instruments, studies eliciting utility values for oral health outcomes and clinical dentistry textbooks and based on the findings, a draft classification system was developed. To refine the draft classification system, semi-structured interviews were conducted among a convenience sample of 15 12–17-year-old adolescents who had experience with dental caries. The classification system was further refined and validated by a group of dental experts, using a modified Delphi technique. Results: The classification system comprised five items (pain/discomfort, difficulty in eating food/drinking, worried, ability to participate in activities, and appearance) and each item had a four-level response scale. Conclusion: The classification system developed herein is considered an amenable tool for the subsequent development of a new PBM for dental caries. Once the scoring algorithm is completed, the classification system can be used to incorporate economic evaluations of dental caries health interventions.</p