Habib Benzian

‘Fit for school’ – a school-based water, sanitation and hygiene programme to improve child health: Results from a longitudinal study in Cambodia, Indonesia and Lao PDR

BackgroundThe Fit for School (FIT) programme integrates school health and Water, Sanitation and Hygiene interventions, which are implemented by the Ministries of Education in four Southeast Asian countries. This paper describes the findings of a Health Outcome Study, which aimed to assess the two-year effect of the FIT programme on the parasitological, weight, and oral health status of children attending schools implementing the programme in Cambodia, Indonesia and Lao PDR.MethodsThe study was a non-randomized clustered controlled trial with a follow-up period of two years. The intervention group consisted of children attending public elementary schools implementing the FIT programme, including daily group handwashing with soap and toothbrushing with fluoride toothpaste, biannual school-based deworming; as well as construction of group handwashing facilities. Control schools implemented the regular government health education curriculum and biannual deworming. Per school, a random selection of six to seven-year-old grade-one students was drawn. Data on parasitological infections, anthropometric measurements, dental caries, odontogenic infections and sociodemographic characteristics were collected at baseline and at follow-up (24xa0months later). Data were analysed using the χ2-test, Mann Whitney U-test and multilevel logistic and linear regression.ResultsA total of 1847 children (mean agexa0=xa06.7xa0years, range 6.0–8.0xa0years) participated in the baseline survey. Of these, 1499 children were available for follow-up examination – 478, 486 and 535 children in Cambodia, Indonesia and Lao PDR, respectively. In all three countries, children in intervention schools had a lower increment in the number of decayed, missing and filled permanent teeth between baseline and follow-up, in comparison to children in controls schools. The preventive fraction was 24% at average. The prevalence of soil-transmitted helminth infection (which was unexpectedly low at baseline), the prevalence of thinness and the prevalence of odontogenic infections did not significantly differ between baseline and follow-up, nor between intervention and control schools.ConclusionsThe study found that the FIT programme significantly contributed to the prevention of dental caries in children. This study describes the challenges, learnings and, moreover, the importance of conducting real-life implementation research to evaluate health programmes to transform school settings into healthy learning environments for children.The study is retrospectively registered with the German Clinical Trials Register, University of Freiburg (Trial registration number: DRKS00004485, date of registration: 26th of February, 2013).

Promoting Oral Health through Programs in Middle Childhood and Adolescence

Oral diseases are among the most common diseases worldwide, particularly for school-age children and adolescents. They pose significant public health problems for all countries and entail substantial health, social, and economic impacts. Simple and effective interventions exist to prevent most oral diseases. The school setting, among others, plays an important role. This chapter describes oral disease control priorities for school-age children and adolescents ages 5–19 years. Oral diseases and effective population-based interventions are highlighted in two other chapters in the Disease Control Priorities (third edition) series: chapter 10 in volume 1 (Niederman, Feres, and Ogunbodede 2015) and chapter 5 in volume 3 (Sankaranarayanan and others 2015). Definitions of age groupings and age-specific terminology used in this volume can be found in chapter 1 (Bundy and others 2017).

Current employment characteristics and career intentions of Lithuanian dentists

BackgroundThe present survey explored the current employment profile and future career intentions of Lithuanian general dentists and specialists.MethodsA census sampling method was employed with data collected by means of a structured questionnaire that inquired about demographics, different employment-related aspects (practice type and location, working hours, perceived lack of patients, etc.), and future career intentions (intent to emigrate, to change profession, or the timing of retirement). The final response rate was 67.6% corresponding to 2,008 respondents.ResultsThe majority of all dentists work full or part-time in the private dental sector, more than one third of them owns a private practice or rents a dental chair. A minority of dentists works in the public dental sector. According to the survey, 26.6% of general dentists and 39.2% of dental specialists works overtime (>40xa0hours per week; P <0.001) and practice in multiple clinics (1.4u2009±u20090.6 and 2.0u2009±u20091.2, respectively; P <0.001). One third of general dentists (31.3%) and dental specialists (31.4%) stated to have a low number of patients (P >0.05). The majority (68.9% of general dentists and 65.9% of dental specialists) plans to work after the retirement age (P >0.05). Emigration as an option for their professional career is being considered by 10.8% of general dentists and 8.3% of dental specialists (P >0.05). Working either full or part-time in private practices (ORu2009=u20094.3) and younger age (≤35xa0years; ORu2009=u20092.2) are the two strongest predictors for a perceived insufficient number of patients.ConclusionsOne third of dentists in Lithuania work long hours and lack patients. Many dentists practice in multiple locations and plan to retire after the official retirement age. Some dentists and dental specialists plan to emigrate. The perceived shortcomings within the dental care system and workforce planning of dentists need to be addressed.

Political priority of oral health in Italy: an analysis of reasons for national neglect

PURPOSEnOral health remains a neglected area and its political priority on most national agendas is low. This analysis aimed to identify the political priority of oral health in Italy.nnnBACKGROUNDnItalian public health services are decentralised at the regional level and are financed by both central and local authorities. Despite certain legally guaranteed public oral health services, access to oral health care seems to be inhomogeneous.nnnMETHODSnAppraisal of the political priority of oral health in Italy uses the Political Power Framework as proposed by Shiffman and Smith.nnnRESULTS AND DISCUSSIONnThere is no clear mandate for leadership or coordination within the oral health sector, resulting in fragmentation and in dominance of the private sector. As a consequence, oral diseases are mainly addressed through a curative rather than a preventive public health approach. Current, systematic and representative data are lacking. Therefore, the real burden of oral diseases is unknown and thus cannot be addressed adequately. Evidence-based, cost-effective and sustainable population-wide public dental health interventions are not implemented on a large scale, and growing inequities in terms of access to care are not seen as a concern.nnnCONCLUSIONnLack of relevant policies with a public health focus, absence of systematic oral health surveillance and limited access to care for large population groups are strong indicators that oral health is not a political priority. However, opportunities in the wider political environment could be used to facilitate analysis, discussion and change in order to improve political priority of oral health in Italy.

Political priority of oral health in India: analysis of the reasons for neglect: Political priority of oral health in India

OBJECTIVESnTo examine the political priority of oral health in India and to understand the underlying reasons for the political support oral health receives.nnnMETHODSnThe analysis is based on the political power framework developed by Shiffman and Smith and modified by Benzian et al. to examine the factors that contribute to the political priority of oral health in India. The framework comprises four main analysis categories, further subdivided into 11 dimensions. Based on the set of criteria, each dimension was analyzed and rated by assigning a score to assess to what extend the criteria were met.nnnRESULTSnThere is a good understanding on what defines an oral health problem, however, there is no consolidated and comprehensive approach to address oral diseases. Despite Indias efforts to improve oral health-related research, its poor utilization in terms of public health and population-based approaches is apparent. The absence of a national surveillance system for oral health masks the severity and extent of the oral disease burden and limits the basis for advocacy on improving oral health to health decision makers. The fragmentation of actors and institutions and the absence of leaders uniting various actors in oral public health impede changes toward improving the oral health status of the population.nnnCONCLUSIONSnLimited accessibility to oral health care, poor portrayals of the severity and extent of the burden, and inertia to address-related challenges are important factors contributing to the low political priority of oral health.

Nutritional status, dental caries and tooth eruption in children: a longitudinal study in Cambodia, Indonesia and Lao PDR

BackgroundUntreated dental caries is reported to affect children’s nutritional status and growth, yet evidence on this relationship is conflicting. The aim of this study was to assess the association between dental caries in both the primary and permanent dentition and nutritional status (including underweight, normal weight, overweight and stunting) in children from Cambodia, Indonesia and Lao PDR over a period of 2 years. A second objective was to assess whether nutritional status affects the eruption of permanent teeth.MethodsData were used from the Fit for School - Health Outcome Study: a cohort study with a follow-up period of 2 years, consisting of children from 82 elementary schools in Cambodia, Indonesia and Lao PDR. From each school, a random sample of six to seven-year-old children was selected. Dental caries and odontogenic infections were assessed using the World Health Organization (WHO) criteria and the pufa-index. Weight and height measurements were converted to BMI-for-age and height-for-age z-scores and categorized into weight status and stunting following WHO standardised procedures. Cross-sectional and longitudinal associations were analysed using the Kruskal Wallis test, Mann Whitney U-test and multivariate logistic and linear regression.ResultsData of 1499 children (mean age at baselineu2009=u20096.7xa0years) were analyzed. Levels of dental caries and odontogenic infections in the primary dentition were significantly highest in underweight children, as well as in stunted children, and lowest in overweight children. Dental caries in six to seven-year old children was also significantly associated with increased odds of being underweight and stunted 2 years later. These associations were not consistently found for dental caries and odontogenic infections in the permanent dentition. Underweight and stunting was significantly associated with a lower number of erupted permanent teeth in children at the age of six to seven-years-old and 2 years later.ConclusionsUnderweight and stunted growth are associated with untreated dental caries and a delayed eruption of permanent teeth in children from Cambodia, Indonesia and Lao PDR. Findings suggest that oral health may play an important role in children’s growth and general development.Trial registrationThe study was restrospectively registered with the German Clinical Trials Register, University of Freiburg (trial registration number: DRKS00004485; date of registration: 26th of February, 2013).

Going Global: Toward Competency-Based Best Practices for Global Health in Dental Education

The Global Oral Health Interest Group of the Consortium of Universities for Global Health (GOHIG-CUGH) published recommended competencies to support development of competency-based global health education in dental schools. However, there has been no comprehensive, systematically derived, or broadly accepted framework for creating and delivering competency-based global health education to dental students. This article describes the results of a collaborative workshop held at the 2016 American Dental Education Association (ADEA) Annual Session & Exhibition designed to build on the GOHIG-CUGH competencies and start to develop systematic approaches for their practical application. Workshop organizers developed a preliminary theoretical framework for guiding the development of global health in dental education, grounded in published research. Collectively, workshop participants developed detailed outcomes for the theoretical framework with a focus on three educational practices: didactic, experiential, and research learning and how each can meet the competencies. Participants discussed learning objectives, keys to implementation, ethical considerations, challenges, and examples of success. Outcomes demonstrated that no educational practice on its own meets all 33 recommended competencies for dental students; however, the three educational practices combined may potentially cover all 33. Participants emphasized the significance of sustainable approaches to student learning for both students and communities, with identified partners in the communities to collaborate on the development, implementation, evaluation, and long-term maintenance of any student global health activity. These findings may represent early steps toward professional consensus and best practices for global health in dental education in the United States.