Challenges of rapid migration to fully virtual education in the age of the Corona virus pandemic: experiences from across the world

The social disruption caused by the sudden eruption of the Corona Virus pandemic has shaken the whole world, influencing all levels of education immensely. Notwithstanding there was a lack of preparedness for this global public health emergency which continues to affect all aspects of work and life. The problem is, naturally, multifaceted, fast evolving and complex, affecting everyone, threatening our well-being, the global economy, the environment and all societal and cultural norms and our everyday activities. In a recent UNESCO report it is noted that nearly a billion and a quarter (which is 67,7 % of the total number) of learners have been affected by the Corona Virus pandemic worldwide. The education sector at all levels has been one of the hardest hit sectors particularly as the academic/school year was in full swing. The impact of the pandemic is widespread, representing a health hazard worldwide. Being such, it profoundly affects society as a whole, and its members that are, in particular, i) individuals (the learners, their parents, educators, support staff), ii) schools, training organisations, pedagogical institutions and education systems, iii) quickly transformed policies, methods and pedagogies to serve the newly appeared needs of the latter. Lengthy developments of such scale usually take years of consultation, strategic planning and implementation. In addition to raising awareness across the population of the dangers of the virus transmission and instigating total lockdown, it has been necessary to develop mechanisms for continuing the delivery of education as well as demanding mechanisms for assuring the quality of the educational experience and educational results. There is often scepticism about securing quality standards in such a fast moving situation. Often in the recent past, the perception was that courses and degrees leading to an award are inferior if the course modules (and sometimes its assessment components) were wholly online. Over the last three decades most Higher Education institutions developed both considerable infrastructure and knowhow enabling distance mode delivery schools (Primary and Secondary) had hardly any necessary infrastructure nor adequate knowhow for enabling virtual education. In addition, community education and various training providers were mainly delivered face-to-face and that had to either stop altogether or rapidly convert materials, exercises and tests for online delivery and testing. A high degree of flexibility and commitment was demanded of all involved and particularly from the educators, who undertook to produce new educational materials in order to provide online support to pupils and students. Apart from the delivery mode of education, which is serving for certificated programmes, it is essential to ensure that learners’ needs are thoroughly and continuously addressed and are efficiently supported throughout the Coronavirus or any other future lockdown. The latter can be originated by various causes and reasons that vary in nature, such as natural or socioeconomical. Readiness, thus, in addition to preparedness, is the primary key question and solution when it comes to quality education for any lockdown. In most countries, the compulsory primary and secondary education sectors have been facing a more difficult challenge than that faced by Higher Education. The poor or in many cases non-existent technological infrastructure and low technological expertise of the teachers, instructors and parents, make the delivery of virtual education difficult or even impossible. The latter, coupled with phenomena such as social exclusion and digital divide where thousands of households do not have adequate access to broadband Internet, Wi-Fi infrastructure and personal computers hamper the promising and strenuous virtual solutions. The shockwaves of the sudden demands on all sectors of society and on individuals required rapid decisions and actions. We will not attempt to answer the question “Why was the world unprepared for the onslaught of the Coronavirus pandemic” but need to ascertain the level of preparedness and readiness particularly of the education sector, to effect the required rapid transition. We aimed to identify the challenges, and problems faced by the educators and their institutions. Through first-hand experiences we also identify best practices and solutions reached. Thus we constructed a questionnaire to gather our own responses but also experiences from colleagues and members of our environment, family, friends, and colleagues. This paper reports the first-hand experiences and knowledge of 33 co-authors from 27 institutions and from 13 different countries from Europe, Asia, and Africa. The communication technologies and development platforms used are identified; the challenges faced as well as solutions and best practices are reported. The findings are consolidated into the four areas explored i.e. Development Platforms, Communications Technologies, Challenges/Problems and Solutions/Best Practices. The conclusion summarises the findings into emerging themes and similarities. Reflections on the lasting impact of the effect of Coronavirus on education, limitations of study, and indications of future work complete the paper

Dental caries in primary and permanent teeth in children's worldwide, 1995 to 2019: a systematic review and meta-analysis

Background: Early childhood caries (ECC) is a type of dental caries in the teeth of infants and children that is represented as one of the most prevalent dental problems in this period. Various studies have reported different types of prevalence of dental caries in primary and permanent teeth in children worldwide. However, there has been no comprehensive study to summarize the results of these studies in general, so this study aimed to determine the prevalence of dental caries in primary and permanent teeth in children in different continents of the world during a systematic review and meta-analysis. Methods: In this review study, articles were extracted by searching in the national and international databases of SID, MagIran, IranMedex, IranDoc, Cochrane, Embase, ScienceDirect, Scopus, PubMed, and Web of Science (ISI) between 1995 and December 2019. Random effects model was used for analysis and heterogeneity of studies was evaluated by using the I2 index. Data were analyzed by using the Comprehensive Meta-Analysis (Version 2) software. Findings: In this study, a total of 164 articles (81 articles on the prevalence of dental caries in primary teeth and 83 articles on the prevalence of dental caries in permanent teeth) were entered the meta-analysis. The prevalence of dental caries in primary teeth in children in the world with a sample size of 80,405 was 46.2% (95% CI: 41.6–50.8%), and the prevalence of dental caries in permanent teeth in children in the world with a sample size of 1,454,871 was 53.8% (95% CI: 50–57.5%). Regarding the heterogeneity on the basis of meta-regression analysis, there was a significant difference in the prevalence of dental caries in primary and permanent teeth in children in different continents of the world. With increasing the sample size and the year of study, dental caries in primary teeth increased and in permanent teeth decreased. Conclusion: The results of this study showed that the prevalence of primary and permanent dental caries in children in the world was found to be high. Therefore, appropriate strategies should be implemented to improve the aforementioned situation and to troubleshoot and monitor at all levels by providing feedback to hospitals

A comparative study on oral health status in Greek preschool children with neurodevelopmental disorders with movement limitations

AIM: To assess the oral health status of preschool children with neurodevelopmental disorders (NDD) in Greece and compare it to that, of healthy children of the same age. METHODS AND RESULTS: The sample consisted of 146 preschool children with NDD and movement limitations attending the rehabilitation centers of ELEPAP and 165 healthy children matched for age and maternal origin. Caries prevalence, dmft index, precavitated carious lesions (WSL) prevalence Visual Plaque Index (VPI), Restorative Index (RI), Mutans Streptococci (MS) levels, saliva buffer capacity, gingival hyperplasia, tooth wear and developmental dental defects were assessed. Data were analyzed using parametric and nonparametric tests (P ≤.05). The NDD group, compared to the healthy controls, had significantly lower caries prevalence (P <.001), dmft index (P <.001), VPI (P <.001) and MS levels (P = .027), significantly higher WSL prevalence (P <.001), and visited the dentist at an older age (P <.001). Significant determinants of WSL in the NDD group was the VPI (P = .009) and the presence of MS (P <.028). CONCLUSION: Preschool children with NDD had lower prevalence of manifested caries but higher prevalence of WSL. However, most oral health parameters need improvement for both groups indicating the need for proper early interventions especially in the NDD group. © 2019 Special Care Dentistry Association and Wiley Periodicals, Inc

Validation of different Cariogram settings and factor combinations in preschool children from areas with high caries risk

Background: Caries risk assessment in preschool children has been limited validated. Aim: To validate caries predictive ability of Cariogram using different combinations of factors and settings in preschool children from areas with high caries risk. Design: Two to five years old children (N = 175) were examined for caries (cavitated and non-cavitated lesions), at baseline and after 1 and 2 years. Mutans streptococci counts (MS) and saliva buffer capacity (SBC) were measured with chair side tests. Diet and oral health attitude were assessed through a parental questionnaire. Baseline caries risk was calculated using standard and high-risk group variables in Cariogram either with nine factors or excluding MS and SBC. Poisson regression models, ROC analysis and information criteria (AIC and BIC), P < 0.05, were used to investigate the predictive ability of Cariograms and to quantify the associations. Results: Accuracy of Cariogram was found limited. Cariograms with MS showed higher sensitivity but lower specificity than those without bacterial counts. Standard set Cariograms with MS counts performed slightly better than the other models, but the difference was not statistically significant. Caries prediction with standard and high set Cariograms was also found limited. Conclusions: Cariogram with various factors and settings displayed suboptimal ability to predict caries in this population. © 2019 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Lt

Rehabilitation Considerations for Very Young Children with Severe Oligodontia due to Ectodermal Dysplasia: Report of Three Clinical Cases with a 2-Year Follow-Up

Introduction. Management of oligodontia can be complicated and requires multidiscipline care, involving a wide spectrum of interventions. The aim of this report is to describe the challenges of oral rehabilitation of three very young children with oligodontia. Report. Three preschool aged Caucasian males, diagnosed with ectodermal dysplasia, were treated with interim removable dentures in order to replace missing teeth, reclaim vertical dimension, and improve function and aesthetics. The main challenges faced were patient cooperation, dental and skeletal characteristics, and parental expectations. Two years post-treatment, both patients and parents reported excellent adaptation to prosthesis and satisfaction with aesthetics. Conclusion. Rehabilitation of oligodontia may be challenging due to accompanying oral findings, dentofacial growth considerations, and behavioral issues. Establishment of good rapport between patients, parents, and clinician is the key for the success of the treatment even with the use of nonpharmacological behavioral management techniques. © 2022 Kyriaki Seremidi et al

Caries risk assessment with the ‘Bangkok checklist’ in preschool children: A prospective cohort study

Background: Caries risk assessment in preschool children is poorly validated in prospective studies. Aim: To validate the Bangkok checklist (BCL) in predicting caries development in a cohort of preschool children from low and moderate socioeconomic areas and compare it with two established risk assessment tools. Design: We followed 146 preschool children, aged 2-5 years for 2 years. At baseline, the caries risk category (low, moderate, high) was determined with three checklists: (a) BCL, (b) American Academy of Pediatric Dentistry form (CRAF), and (c) Caries Management By Risk Assessment (CAMBRA). Data were collected from questionnaires and clinical examinations. Caries increment was recorded by counting the number of surfaces that changed from sound to decayed. We used Kendall's tau, Poisson regression models and ROC analysis to assess the predictive ability of the different checklists. Results: Over 50% of the children developed new caries on a yearly basis. The BCL assigned the majority of the children (87%) into the high-risk category. Sensitivity was 88% but specificity was low (16%). Accuracy of BCL was similar to CRAF but inferior to CAMBRA. Conclusions: Bangkok checklist had a very limited performance in accurately predicting future early childhood caries in this population. © 2021 BSPD, IAPD and John Wiley & Sons Lt

Knowledge of preschool teachers in the prefecture of Attica of early childhood oral health. Association with their demographic and personal characteristics

Aim: To investigate the knowledge of preschool teachers of early childhood oral health (OH) and its association with demographic and educational characteristics as well as with personal oral health habits and attitudes. Methods: Teachers (594) of preschool children were invited to complete a questionnaire with 40 questions on demographic data, knowledge of early childhood OH issues, personal OH habits and attitudes, and participation in OH educational programmes at preschools. Statistical analysis included descriptive statistics, Spearman correlation coefficients, multiple linear and logistic regression modelling (p ≤ 0.05). Results: The mean age of participants was 40.9 years (SD 7.5), 68.5% of them had children of their own, 72.6% had not attended any OH educational course during their studies, 70% believed that they had insufficient knowledge to implement an OH educational programme, 44.6% had implemented such a programme, 26.8% knew that the first dental visit should be at a child’s first birthday and 36.7% knew the correct age that tooth brushing should start. The most significant factors that influenced overall teachers’ knowledge on early childhood oral health were: their participation in OH educational programmes (p < 0.001), their belief that OH courses during their studies were necessary (p = 0.01), their confidence on OH knowledge (p = 0.03) and parenthood (p = 0.05). Conclusions: Based on the results of this study, there was a lack of knowledge among preschool teachers in significant OH issues for that age. Moreover, limitations in implementing OH educational programmes at preschools were attributed mainly to lack of self-confidence in relevant knowledge. Nevertheless, participants acknowledged the significance of OH and were willing to participate in relevant teacher training. © 2016, European Academy of Paediatric Dentistry

Caries-preventive effectiveness of fluoride varnish as adjunct to oral health promotion and supervised tooth brushing in preschool children: a double-blind randomized controlled trial.

OBJECTIVES To evaluate the effect of biannual fluoride varnish applications in preschool children as an adjunct to school-based oral health promotion and supervised tooth brushing with 1000ppm fluoride toothpaste. METHODS 424 preschool children, 2-5 year of age, from 10 different pre schools in Athens were invited to this double-blind randomized controlled trial and 328 children completed the 2-year programme. All children received oral health education with hygiene instructions twice yearly and attended supervised tooth brushing once daily. The test group was treated with fluoride varnish (0.9% diflurosilane) biannually while the control group had placebo applications. The primary endpoints were caries prevalence and increment; secondary outcomes were gingival health, mutans streptococci growth and salivary buffer capacity. RESULTS The groups were balanced at baseline and no significant differences in caries prevalence or increment were displayed between the groups after 1 and 2 years, respectively. There was a reduced number of new pre-cavitated enamel lesions during the second year of the study (p=0.05) but the decrease was not statistically significant. The secondary endpoints were unaffected by the varnish treatments. CONCLUSIONS Under the present conditions, biannual fluoride varnish applications in preschool children did not show significant caries-preventive benefits when provided as an adjunct to school-based supervised tooth brushing with 1000ppm fluoride toothpaste. CLINICAL SIGNIFICANCE In community based, caries prevention programmes, for high caries risk preschool children, a fluoride varnish may add little to caries prevention, when 1000ppm fluoride toothpaste is used daily

Developmental defects of enamel in first permanent molars associated with use of asthma drugs in preschool aged children: A retrospective case-control study

Aim: To investigate the association between the occurrences of developmental defects of enamel (DDE), in first permanent molars, and bronchodilators and/or corticosteroid intake for asthma-like episodic treatment at preschool age, in 6–12 year old children. Methods: Children of the case group (n = 70) were followed in the Paediatric Pulmonary Unit and the Unit of Allergology, Asthma and Inflammation at ‘Aghia Sofia’ Children’s Hospital, Athens, Greece and had used asthma drugs during their first 4 years of life. The control group (n = 70) consisted of healthy children who visited the Postgraduate Paediatric Dental Clinic, University of Athens. Information regarding demographic data, medical history, pregnancy, birth weight, duration of breastfeeding, mother’s smoking habits and antibiotic use at preschool age was obtained through a structured questionnaire. Details concerning asthma drugs used were extracted from medical records. The children in both groups underwent an oral examination under standard clinical conditions and all surfaces of first permanent molars were assessed for enamel defects using the modified DDE Index. Chi square statistics, Mann–Whitney U test, Spearman correlation coefficient and logistic regression analysis were used for statistical analysis of the data (p ≤ 0.05). Results: DDE were present in 24 children (34.3%) in the case group and only in 6 (8.6%) in the control, with the difference between the two groups being statistically significant (p < 0.001), while the estimated odds ratio was 5.56. Among the children with DDE in the case group, 41.6% had at least one hypoplastic molar with loss of enamel. The type of asthma drug, age at treatment onset and duration of drug use were not significantly associated with the severity or extent of DDE. Among the possible influential factors, gender was the only statistical significant factor. Conclusions: Children treated with asthma drugs for asthma-like episodes at a preschool age showed an overall increased risk for developing enamel defects in their first permanent molars. Severe hypoplastic lesions with loss of enamel was a frequent finding among affected molars. © 2017, European Academy of Paediatric Dentistry

A 5-year data report of traumatic dental injuries in children and adolescents from a major dental trauma center in Greece

Background/Aim: Prevalence and demographic characteristics of traumatic dental injuries (TDI) differ in different countries. The aim of this retrospective study was to assess TDI in primary and permanent teeth among children and adolescents who presented to the Department of Paediatric Dentistry, National and Kapodistrian University of Athens, Greece, during the last 5 years. Material and Methods: Dental records of 236 new patients who presented with dento-alveolar trauma to the Postgraduate Dental Clinic from 1/1/2014 to 31/12/2019 were reviewed. Data recorded were gender, age, month of the year the injury occurred, type of trauma, and number of traumatized teeth. Injuries were classified as fracture, luxation, or combination injuries. Descriptive statistics, chi-squared (x2), and Fisher's exact tests were used to evaluate the results. Level of significance was set at 5%. Results: The age of the patients ranged from 1 to 18 years old, with a mean of 8.63 years (SD: 3.52). There were 395 anterior traumatized teeth and 2 cases with traumatized posterior teeth. Children suffered trauma more often at the ages of 5 years, 7 years, and 11 years. In this cohort, 60% were boys who had a higher chance of having trauma than girls (odds ratio = 1.418 95% CI = 0.724, 2.777). Most TDI occurred in March and May, followed by June and February, and most traumatized teeth were permanent (80%). Maxillary central incisors in both dentitions were injured most often and significantly more compared to lateral incisors (p < 0.01). The most common type of injury was a fracture in the permanent dentition (60%) and luxation injuries (69%) in the primary dentition. Conclusions: Traumatic dental injuries in this cohort occurred mostly in spring, affected boys more than girls, permanent teeth more than primary teeth, maxillary incisors more than mandibular incisors, and central incisors more than lateral incisors, while children aged 5, 7, and 11 years old had the most injuries. © 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd