Impact of Sense of Coherence on Oral Health Behaviors: A Systematic Review

<div><p>Objectives</p><p>The aim of this review was to critically analyze the empirical evidence on the association between Sense of Coherence (SOC) and oral health behaviors through a systematic approach.</p><p>Methods</p><p>A systematic search up to April 2015 was carried out using the following electronic bibliographic databases: PubMed, Ovid MEDLINE; ISI Web of Science; and Ovid PsychInfo. Studies were included if they evaluated the relationship between SOC and oral health behaviors including tooth cleaning, fluoride usage, dietary habits, dental attendance, and smoking. We excluded studies that only assessed the relationship between oral health status and SOC without evaluating oral health behaviors. The New Castle Ottawa (NOS) quality assessment checklist was employed to evaluate the methodological quality of included studies.</p><p>Results</p><p>Thirty-nine potential papers met the preliminary selection criteria and following a full-text review, 9 papers were finally selected for this systematic review. Results provided by the included studies indicated different levels of association between SOC and oral health behaviors. The most frequent behaviors investigated were tooth brushing and dental attendance pattern. The impact of SOC on performing positive oral health behaviors, to some extent, was related to demographic and socio-economic factors. In addition, mothers’ SOC influenced children’s oral health practices.</p><p>Conclusions</p><p>A more favorable oral health behavior was observed among those with a stronger SOC suggesting that the SOC can be a determinant of oral health-related behaviors including tooth brushing frequency, daily smoking, and dental attendance.</p></div

Summary of descriptive characteristics of finally selected studies.

<p>* The original English questionnaires were translated into two local languages, namely Afrikaans and Sepedi for use with a few learners who were not proficient in English; otherwise the surveys were conducted in English.</p><p>** Although all the items of the SOC-13 loaded on three factors, the original three-factor structure of the SOC-13 could not be replicated in this adolescent population. only six out of 13 items were replicated for this population; however, the internal consistency coefficient was similar to that of the SOC-13 when comparing them as a unidimensional scale.</p><p>***These studies employed an abbreviated form of SOC-13 scale by removing one item to provide equal number of 4 items to measure three constructs of SOC.</p><p>**** This study reported SOC score on a 7-point range.</p><p>***** Participants have a wide age range which categorized into groups: <i>Participants were classified into of the following age groups</i>: <i>20</i>, <i>30</i>, <i>40</i>, <i>50</i>, <i>60</i>, <i>70 and 80 years of age</i>. <i>No mean for total or each age group has provided</i>. <i>The age was classified into four categories</i>, <i>30–39 years old</i>, <i>40–49 years old</i>, <i>50–59 years old and 60–64 years old</i>. <i>No mean for total or each age group has provided</i>. <i>The age was classified into four categories 40–49</i>, <i>50–59</i>, <i>60–69</i>, <i>and 70–80</i>. <i>No mean for total or each age group has provided</i>.</p><p>****** For each behavior SOC was mentioned separately. Refer to table 2 of the article Lindmark et al., 2011 [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0133918#pone.0133918.ref030" target="_blank">30</a>].</p><p>Summary of descriptive characteristics of finally selected studies.</p

Search Strategy (in PubMed).

<p>Search Strategy (in PubMed).</p

Quality assessment of included cohort studies based on the Newcastle-Ottawa scale.

<p>*a maximum of 1 point for each item</p><p>**a maximum of 2 points for each item</p><p>***a maximum of 1 point for each item</p><p>****a maximum of 9 points</p><p>¹ a) truly representative of the average individuals in the community *, b) somewhat representative of the average individuals in the community *, c) selected group of users, d) no description of the derivation of cohort</p><p>² a) drawn from the same community as the exposed group *, b) drawn from a different source, c) no description of the derivation of the non-exposed-group</p><p>³ a) secure record *, b) structured interview or questionnaire *, c) written self reports, d) no description</p><p>⁴ a) yes *, b) no</p><p>⁵ a) study control for one confounding variable *, b) study control for 2 or more confounding variables **</p><p>⁶ a) independent blind assessment *, b) record linkage *, c) self reports d) no description</p><p>⁷ a) yes (select an adequate follow up period for outcome of interest *, b) no</p><p>⁸ a) complete follow up—all subjects accounted for *, b) subjects lost to follow up are unlikely to introduce bias—≤20% loss or ≥80% follow up, or description provided of those lost *, c) ≥20% loss or ≤80% follow up, or no description of those lost, d) no statement</p><p>[<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0133918#pone.0133918.ref025" target="_blank">25</a>]</p

New Castle Ottawa (NOS) Quality Assessment [26]^*.

<p>*Note: NOS adapted for cross-sectional studies.</p><p>A study can be awarded a maximum of one star (representing “yes”) for each numbered item within the Selection and Outcome categories. A maximum of two stars can be given for Comparability. [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0133918#pone.0133918.ref027" target="_blank">27</a>,<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0133918#pone.0133918.ref028" target="_blank">28</a>]</p><p>New Castle Ottawa (NOS) Quality Assessment [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0133918#pone.0133918.ref026" target="_blank">26</a>]^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0133918#t003fn001" target="_blank">*</a>}.</p

Randomized clinical trials in dentistry: Risks of bias, risks of random errors, reporting quality, and methodologic quality over the years 1955–2013

<div><p>Objectives</p><p>To examine the risks of bias, risks of random errors, reporting quality, and methodological quality of randomized clinical trials of oral health interventions and the development of these aspects over time.</p><p>Methods</p><p>We included 540 randomized clinical trials from 64 selected systematic reviews. We extracted, in duplicate, details from each of the selected randomized clinical trials with respect to publication and trial characteristics, reporting and methodologic characteristics, and Cochrane risk of bias domains. We analyzed data using logistic regression and Chi-square statistics.</p><p>Results</p><p>Sequence generation was assessed to be inadequate (at unclear or high risk of bias) in 68% (n = 367) of the trials, while allocation concealment was inadequate in the majority of trials (n = 464; 85.9%). Blinding of participants and blinding of the outcome assessment were judged to be inadequate in 28.5% (n = 154) and 40.5% (n = 219) of the trials, respectively. A sample size calculation before the initiation of the study was not performed/reported in 79.1% (n = 427) of the trials, while the sample size was assessed as adequate in only 17.6% (n = 95) of the trials. Two thirds of the trials were not described as double blinded (n = 358; 66.3%), while the method of blinding was appropriate in 53% (n = 286) of the trials. We identified a significant decrease over time (1955–2013) in the proportion of trials assessed as having inadequately addressed methodological quality items (P < 0.05) in 30 out of the 40 quality criteria, or as being inadequate (at high or unclear risk of bias) in five domains of the Cochrane risk of bias tool: sequence generation, allocation concealment, incomplete outcome data, other sources of bias, and overall risk of bias.</p><p>Conclusions</p><p>The risks of bias, risks of random errors, reporting quality, and methodological quality of randomized clinical trials of oral health interventions have improved over time; however, further efforts that contribute to the development of more stringent methodology and detailed reporting of trials are still needed.</p></div

Flow diagram of data search according to PRISMA [24].

<p>Flow diagram of data search according to PRISMA [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0133918#pone.0133918.ref024" target="_blank">24</a>].</p

Risk of bias assessment by domain over time (N = 540), N (%).

<p>Risk of bias assessment by domain over time (N = 540), N (%).</p

Number of oral heath trials according to year of publication.

<p>Number of oral heath trials according to year of publication.</p

Flow diagram of the literature search [20, 21].

<p>Flow diagram of the literature search [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0190089#pone.0190089.ref020" target="_blank">20</a>, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0190089#pone.0190089.ref021" target="_blank">21</a>].</p