Oral health status, oral health-related quality of life and associated factors among Nepalese schoolchildren

Abstract This national cross-sectional study aimed to measure the oral health status, and oral health related-quality of life (OHRQoL) among Nepalese schoolchildren. Another aim was to investigate the association of dental caries and its consequences with OHRQoL, sociodemographic factors, oral health-related behaviours, anthropometrics, and school attendance and performance. The study was conducted in 18 out of total 75 randomly selected districts of Nepal representing 5 developmental, and concurrently 3 simultaneously ecological regions. Altogether 1137 of the invited 1157 schoolchildren from 27 conveniently selected schools participated both in the survey and clinical examination. Information on sociodemographic factors and oral health-related behaviours was collected using a structured questionnaire. Validated Nepali Child-OIDP was used for assessing children’s OHRQoL. Clinical oral examinations were conducted as per the WHO guidelines and assessed dental caries, its consequences (pufa/PUFA) and periodontal status. BMI, waist-to-hip ratio, and waist-to-height ratio were computed from anthropometric measurements. School-related information included data on school absenteeism was collected from school registry and school performance (percentage of the sum of scores in three core subjects). Gingival bleeding was highly prevalent among all participants. The youngest ones had most often need for dental caries treatment; 79% vs. 64% among the oldest ones. Dental caries and its consequences were most prevalent among those living in the Kathmandu Valley or in the rural areas or in mountain or hilly ecological regions, as well as those consuming sweets or candy, or tea with sugar, and brushing teeth infrequently. Most of the participants had problem with eating, cleaning the mouth, and sleeping. Dental caries and its consequences were associated with poor OHRQoL. They were also associated with both high and low BMI and central obesity (high waist-to-hip and waist-to-height ratios) as well as high school absenteeism (>13% of total schooldays missed) and poor school performance. Both low and high BMI, and poor OHRQoL, as well as high school absenteeism were all inversely associated with school performance. In conclusion, dental caries and gingival bleeding are common among Nepalese schoolchildren. Dental caries and its consequences are associated with poor OHRQoL. These conditions are also associated with sociodemographic factors, poor oral health-related behaviours, and anthropometrics (BMI and central obesity) as well as high school absenteeism and poor school performance.Tiivistelmä Tämän poikkileikkaustutkimuksen tavoitteena oli tutkia nepalilaisten koululaisten suunterveyttä ja siihen liittyvää elämänlaatua (OHRQoL). Toiseksi tavoitteena oli tutkia karieksen ja sen seurausten mm. oireet ja tulehdus, yhteyttä suunterveyteen liittyvään elämänlaatuun, sosiodemografisiin ja antropometrisiin tekijöihin, suunterveyskäyttäytymiseen, koulupoissaoloihin sekä -menestykseen. Tutkimus toteutettiin 18/75 satunnaisesti valitussa Nepalin piirikunnassa, jotka edustivat sekä viittä kehitysaluetta että kolmea ekologista aluetta. Mukaan kutsutuista 1157 koululaisesta (27 koulua, mukavuusotos), 1137 osallistui sekä kysely- että kliiniseen tutkimukseen. Sosiodemografiset taustatiedot sekä tiedot suunterveyskäyttäytymisestä kerättiin strukturoidulla kyselylomakkeella. Suunterveyteen liittyvää elämänlaatua arvioitiin käyttäen validoitua nepalin kielistä Child-OIDP-lomaketta. Kliinisessä tutkimuksessa tutkittiin kariestilanne, sen kliiniset seuraukset (pufa/PUFA) sekä kiinnityskudosten tila WHOn ohjeiden mukaan. BMI, vyötärön ja lantion ympärysmitan suhde sekä vyötärön ympärysmitan ja pituuden suhde laskettiin mittaustulosten perusteella. Kouluista saatiin tiedot poissaoloista viimeisen kouluvuoden aikana sekä koulumenestys kolmessa keskeisimmässä oppiaineessa viimeisimmässä todistuksessa. Lähes kaikilla todettiin ienverenvuotoa. Nuorimmassa ikäryhmässä oli muita useammin korjaavan karieshoidon tarvetta (79 % vs. 64 %). Kariesta sekä sen seurauksia esiintyi eniten niiden keskuudessa, jotka asuivat Kathmandun laaksossa tai vuoristossa. Karieksen esiintyvyys oli myös yhteydessä mm. sokerin, makeisten ja sokeriteen kulutukseen sekä epäsäännölliseen hampaiden harjaukseen. Karies seurauksineen oli yhteydessä huonoon suunterveyteen liittyvään elämänlaatuun (OHRQoL), erityisesti syömiseen, suun puhdistamiseen sekä nukkumiseen. Sillä oli myös yhteys sekä matalaan että korkeaan BMIhin, lisääntyneisiin koulupoissaoloihin sekä huonoon koulumenestykseen. Matala ja korkea BMI, huono suunterveyteen liittyvä elämänlaatu sekä poissaolot olivat käänteisesti yhteydessä koulumenestykseen. Karies ja ienverenvuoto ovat yleisiä nepalilaisten koululaisten keskuudessa. Karies seurauksineen on yhteydessä huonoon suunterveyteen liittyvään elämänlaatuun (OHRQoL), haitalliseen suunterveyskäyttäytymiseen, sosiodemografisiin ja antropometrisiin tekijöihin (BMI, keskivartalolihavuus) sekä lisääntyneisiin koulupoissaoloihin ja huonoon koulumenestykseen

Innovative methodology to guide planning of dental workforce distribution:a GIS-based study in Nepal

Abstract Objectives: To build a predictive model based on the distribution pattern of dentists and population in selective districts of Nepal. Method: Cross-sectional descriptive study conducted using secondary data from the census report and available dentist data of Nepal. Population data were obtained from the most recently available census. For dentists’ data, a literature search was carried out in the databases such as PubMed, Google scholar, One Search and Medline. All data were extracted from the integrated database in the Geographic Information System (GIS), and a predictive model was built. Results: Overall, there was an uneven distribution of dentists in Nepal. When the distribution of dentists was compared with the population clusters, it was found that the slope of the population growth was below or equal to (≤) 20,000 for three provinces (2, 6, and 7), which means that lower numbers of dentists are available with respect to population density in these provinces. The slope was above 50,000 for province 3, and the number of dentists was almost half of the total nationwide. The number of dentists correlated with population clusters. Conclusions: There are substantial disparities in the distribution of dentists in Nepal. Dentists were distributed relative to higher population clusters and were unevenly distributed. The Nepal government should make necessary arrangements to address the need for the human workforce in resource-limited settings. The methods used in this study could be applied globally, as the data used are available for most countries

Adaptation and validation of a Nepali version of the Child-Oral Impacts on Daily Performances Index (C-OIDP)

Abstract The need for culturally validated measures of Oral Health-Related Quality of Life (OHRQoL) has been increasing in recent years. Objectives: To adapt the Child-Oral Impacts on Daily Performances (C-OIDP) index into the Nepali language and to validate it, to assess and compare the outcomes of self-reported oral problems, and to validate a structured questionnaire on general hygiene practices, oral hygiene practices, dietary habits, and use of tobacco. Basic research design: A school-based cross-sectional study on pilot and national samples. Participants: Nepalese schoolchildren representing WHO index age groups (5–6-year-olds, 12-year-olds, and 15-year-olds). The study was conducted on a pilot sample (n=128) selected conveniently and a national sample (n=1,052), selected from 18 sampling sites on the basis of the stratified random sampling method Main outcome measures: Adapted and validated Nepali C-OIDP Results: The Nepali C-OIDP showed excellent validation and reliability tests in both studies. The Cronbach’s alpha coefficients were 0.82 and 0.71 respectively in the pilot and national study. The most common self-reported oral problem was toothache, which was statistically significantly higher in the national sample. Conclusions: The Nepali C-OIDP index is valid and reliable for measuring oral impacts on daily performance among schoolchildren of Nepal

Different risk factors for erosive tooth wear in rural and urban Nepal:a national study

Abstract Background: Erosive tooth wear (ETW) is of growing concern, but data on ETW among Nepalese children are scarce. The main aim of the study was to investigate the prevalence and severity of ETW among Nepalese schoolchildren. We also aimed to analyse the risk indicators for ETW according to location (rural/urban) and the role of obesity in the risk for ETW. Methods: This national study was conducted among 5–15-year-old Nepalese schoolchildren from different regions. Altogether, 1137 out of 1151 schoolchildren participated in both a clinical examination and a survey. ETW was recorded using the Basic Erosive Wear Examination. Results: The prevalence of ETW was 65%. One-fifth of the examined subjects were in need of preventive or restorative treatment. Living in an urban area and studying in a private school were protective factors for ETW, whereas consuming fruits frequently and using charcoal for tooth cleaning increased the odds for ETW. Central obesity was the strongest risk indicator for ETW among urban residents. Conclusions: ETW of low severity is common among Nepalese children and adolescents. Socio-demographic factors influence the prevalence of ETW in Nepal and there seems to be different factors that play a role in the ETW process according to location of residence

A hands-on exercise on caries diagnostics among dental students:a qualitative study

Abstract According to current care practices, the aim is to prevent the onset of caries lesions and to stop the progression of incipient lesions. A visual lesion assessment system, International Caries Detection and Assessment System (ICDAS), has been developed to promote reliability and repeatability of assessment of different stage caries lesions. The aims of this study were to evaluate the experiences of a hands-on exercise with authentic teeth as an adjunct to lecturing among third-year dental students and to evaluate the learning process during the hands-on exercise measured by qualitative (inductive content) analysis of the given feedback. In 2018, 51 third-year dental students at the University of Oulu, Finland, participated in a hands-on exercise on caries detection, where they assessed the depth and activity of lesions in extracted teeth using the ICDAS classification. After the lecture, students evaluated the exercise, giving feedback according to five given topics, three of which were analyzed using inductive content analysis. The exercise was considered useful and necessary but, overall, also challenging. The diverse activities and materials, as well as observational methods, promoted learning. The classification of lesions, the diagnostic methods, and the fact that there was not enough time to adopt things during the exercise were found to be challenging. For developing the exercise, the students suggested that more time should be scheduled for it and there should be more individual teaching. This qualitative study showed that, despite the challenge in caries diagnostics, dental students perceive the hands-on exercise as both a communal and individual learning experience

National reference centiles of anthropometric indices and BMI cut-off values in a child population in Nepal

Abstract Background: There is a need for national- or ethnicity-specific growth reference values in developing countries like Nepal, where rapid urbanisation and consequential nutritional transition is taking place. Aim: To establish national growth reference percentiles for anthropometric indices and to propose body mass index (BMI) cut-off values for Nepalese schoolchildren. Methods: This study comprised 1135 Nepalese schoolchildren of four World Health Organization (WHO) indexed age groups (5-, 6-, 12- and 15-year-olds). The age- and gender-specific smoothed percentile curves for anthropometric indices (height, weight, BMI, waist circumference, waist-to-hip-ratio and waist-to-height-ratio) were constructed using LMS method and the corresponding Z-scores were computed. The Receiver Operating Characteristic analysis was used to determine BMI cut-off values based on the International Obesity Taskforce (IOTF) and the WHO growth references. Results: The age- and gender-specified smoothed percentile values of anthropometric indices at 3rd, 10th, 25th, 50th, 75th, 90th and 97th percentiles were computed. The BMI cut-off values for thinness (−1.2 SDS/12th percentile), overweight (+1.2 SDS/88th percentile) and obesity (+2.1 SDS/98th percentile) had high discriminating power, and high sensitivity and specificity. Conclusion: The Nepali anthropometric cut-off values proposed here can be recommended to be applied into research, and to identify public health risks in Nepal among these age groups

The use of patient-oriented mobile phone apps in oral health:scoping review

Abstract Background: Oral health is a significant part of general health. Poor oral health can influence an individual’s appearance, self-esteem, eating, and speaking. The use of mobile phone apps has been growing in the field of medicine, including dentistry. However, to date, there is no evidence related to the availability of mobile apps focusing on various branches of dentistry. Objective: The aim of this study was to review the scientific literature on the use of patient-oriented mobile phone apps in oral health and summarize the key findings. Methods: A scoping review of published scientific literature on the use of patient-oriented mobile phone apps in oral health was conducted in accordance with the Joanna Briggs Institute. A search was performed in PubMed and Scopus for studies published between January 2000 and June 2021 that were written in English. All study types except for those reporting developmental protocols were included in this review. In total, 2 reviewers independently screened the studies using the eligibility criteria. The study protocol was registered in the Open Science Framework registries in June 2021. Results: The initial search yielded a total of 977 studies, 45 (4.6%) of which met the inclusion criteria. All the studies (45/45, 100%) were published after 2009. Most studies (31/45, 69%) concerned oral health promotion using mobile phone apps, followed by behavior management (5/45, 11%). More than half (23/45, 51%) of the included studies were conducted in Asian countries. Overall, 31% (14/45) of the studies focused on adolescents. A total of 51% (23/45) of the studies were randomized controlled trials (RCTs). Approximately 39% (9/23) of the included RCT studies reported a substantial reduction in dental plaque, and 26% (6/23) of the studies reported significant improvement in gingival health. Regarding dental anxiety management, 13% (3/23) of the RCT studies reported a significant decrease in mean heart rate and lower Facial Image Scale scores. Conclusions: According to the literature, the use of mobile apps in oral health is increasing among patients, mainly children and adolescents. Many studies that have used mobile apps have focused on promoting oral health. However, other areas such as diagnostic and remote consultations (teledentistry) have until recently been neglected despite their great potential

Oral health status associated with sociodemographic factors of Nepalese schoolchildren:a population-based study

Abstract Objectives: The aim of this study was to investigate the oral health of Nepalese schoolchildren relative to their sociodemographic characteristics. Methods: This school‐based, cross‐sectional study was conducted among 5–6‐, 12‐ and 15‐year‐old Nepalese children in 18 randomly selected districts of the 75 in Nepal. Clinical parameters were recorded according to the World Health Organization (WHO) guidelines. Results were presented as mean (SD) and proportions; the chi‐square test, t‐test and one way‐ANOVA were also performed. The risk of dental caries in association with the place of residence was presented according to the outcome of a binary logistic regression analysis. Results: The mean d‐value for the 5–6‐year‐old children was 5.0 (4.22), which was higher than the mean D‐values for the 12‐ and 15‐year‐old subjects, of 1.3 (1.77) and 1.9 (2.28), respectively. The youngest children, as well as children from the Kathmandu Valley, were likely to have more untreated caries lesions than children in the other age groups. The mean number of teeth with severe consequences of dental caries (pulpitis/ulceration/fistula/abscess or pufa/PUFA) was 1.3 (1.91) for the 5–6‐year‐old children, 0.1 (0.35) for the 12‐year‐old children and 0.3 (0.75) for the 15‐year‐old children. All age groups had gingival bleeding on probing in more than 15% of teeth. Children from rural locations had significantly more gingival bleeding than urban children. The same was true for 15‐year‐old girls compared with boys of the same age. Conclusions: Among Nepalese children, oral diseases are common, and geographical variation is prevalent. The health policy should address the alarming oral health situation and need for urgent treatment and population‐based preventive programmes that is evident in Nepal

Acceptability of a mobile application in children’s oral health promotion:a pilot study

Abstract The aim of this pilot study was to investigate the acceptability of an oral health-related mobile application developed for young children based on the feedback given by the children and their parents. Another aim was to evaluate the self-reported change in children’s oral health behaviors during a short test period. The application—a virtual pet integrated into a child’s daily routines—aimed to promote oral hygiene and dietary behaviors in children. A total of 36 4–12-year-old voluntary children were given a mobile phone with the installed application. After the 5-week testing period, the feasibility of the application and possible changes in the children’s oral health behaviors were asked using an electronic questionnaire. Most of the children considered the application clear (n = 34), amusing (n = 31), and useful (n = 29). The children’s tooth brushing manners improved both qualitatively and quantitatively: the time used for tooth brushing increased and the children learned how to brush different tooth surfaces. Mobile applications can be fun and useful in oral health promotion; while playing, children can learn good oral health-related behaviors. Mobile applications integrate oral health promotion into children’s daily environment and routines

Maxillary arch dimensions in 6-year-old cleft children in Northern Finland:a cross-sectional study

Abstract The aim was to cross-sectionally examine the maxillary arch dimensions in 6-year-old children with cleft lip and/or palate and to compare them with the initial cleft sizes among patients with cleft palate. The study included 89 patients with clefts treated at the Oulu University Hospital. The subjects were divided into three groups: cleft palate, cleft lip, and cleft lip and palate. Study casts were scanned, and the maxillary arch dimensions were examined using a 3D program (3Shape Orthoanalyzer, Copenhagen, Denmark). The statistical methods Student’s t-test and one-way ANOVA were used to compare the means (SD) between the groups. Spearman’s correlation coefficient was used to determine the correlation between cleft severity and maxillary dimensions. A significant difference was found between different initial cleft sizes in terms of distance between the second deciduous molar and the first incisor on the right side. The intermolar width showed a negative correlation with the initial cleft size. The dimensions were shorter for clefts affecting the palate and largest for clefts affecting only the lip. Larger clefts resulted in a shorter maxilla on the right side. Many dimensions became shorter when the initial cleft was larger. Clefts of the palate resulted in smaller maxillas