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Objectives: This study evaluated the effect of a flipped oral health educational program for primary healthcare providers (PHCPs) on their knowledge, attitude, and practice. Materials and Methods: This field trial was conducted on PHCPs (N=118; 61 cases and 57 controls) in District Health Centers (DHCs) of Tehran, Iran in 2012. The participants filled out a self-report questionnaire with questions on knowledge (N=34), attitude (N=8), and oral health practice (N=14). The intervention included an educational booklet delivered to the staff followed by a brief educational session using the flipped approach and a reminder pamphlet after 1 month. After 4 months, the questionnaire was completed again by the participants. Statistical analysis included paired sample t-test, ANCOVA, and linear and logistic regression. Results: Most participants were females (N=114), and the mean age was 37±8 years. The scores of the three domains of knowledge and also the total knowledge score, the attitude score, and the practice score significantly improved in the intervention group compared to the control group (P<0.001). Knowledge about the oral health of children (P=0.001) and the total knowledge score (P<0.05) significantly increased in the control group, but the increase in other domains was not statistically significant (P>0.05). Conclusion: The oral health knowledge of PHCPs was insufficient, and their practice and attitude were not desirable. The oral health educational program with the flipped approach had a positive impact on the PHCPs' knowledge, attitude and practice, and may be utilized in the academic curriculum or continuing medical education (CME) courses. [ABSTRACT FROM AUTHOR]

Abstract Background Oral health behavior (OHB), one major factor contributing to proper oral health status, has been addressed insufficiently in addiction literature. The aim of our study was to investigate OHB and its determinants among drug addicts in withdrawal treatment. Methods Through a stratified cluster sampling method, we collected the data from 685 patients in withdrawal treatment in Tehran using self-administered questionnaires on OHB components and conducting interviews about patients’ characteristics and addiction history. The T-test, ANOVA, and a linear regression model served for statistical analysis. Results Of the patients, 48% reported brushing their teeth less than once a day, more than 90% used fluoride toothpaste almost or always, and 81% flossed their teeth rarely or never. Eating sugary products twice a day or more was reported by 57% of the patients and 85% of them were current smokers. Poor OHB was associated with male gender, lower education, being addicted mainly to crystalline heroin, starting drug abuse at a younger age, and having a longer history of addiction (p Conclusion Poor OHB was found among the participants in drug withdrawal treatment. Preventive strategies on oral health should be planned and be integrated into other health promotion programs for addicts along with their withdrawal treatment taking into account special groups at higher risk.

Abstract Background Integration of oral health promotion into general health care has been highly recommended by the World Health Organization. Primary-care physicians can as part of their general health care promote and contribute to improved oral health care. Our aim was to investigate primary-care physicians’ knowledge of oral health, their attitudes toward delivering oral health care (OHC), and their willingness to obtain more education in this field. Methods We conducted a cross-sectional survey of all primary-care physicians working in the public health centers of Tehran city. An anonymous self-administered questionnaire queried their knowledge in pediatric- and general medicine-related areas of dentistry, providing knowledge scores to be calculated for three domains. The physicians’ attitudes toward OHC and willingness to pursue continuous education underwent evaluation with statements utilizing a 5-point Likert scale. Totally, 220 physicians took part in the survey (response rate: 92%). Chi-square test, linear and logistic regression, and t-test served for statistical analyses. Results The physicians’ knowledge score was significantly lower in the pediatric domain than in the dental and medical domains (p < 0.001). The number of physicians answering correctly to the pediatric questions was less than 40%. Almost all physicians (95%) reported it necessary for a physician to know about OHC and admitted (78%) that physicians’ general knowledge in this field is inadequate. Further, 77% of the physicians expressed a will to implement preventive oral health activities in their practice, and almost two-thirds (62%) of them showed a willingness to pursue further education about OHC. Those with higher knowledge scores had a greater willingness to deliver oral health care to their patients. Conclusions Physicians’ lack of knowledge of OHC and their generally positive attitudes toward it revealed a great need for planning of a continuous medical education program in primary care.

Purpose: To determine the prevalence and intensity of oral impacts on daily performance in 20- to 50-year-olds attending the dental clinic at Tehran Dental School and to investigate the association between the Oral Impacts on Daily Performance (OIDP) score, self-reported oral and general health and clinical findings of oral health. Materials and Methods: The study population comprised 20- to 50-year-olds attending the dental clinic before receiving any treatments. Data were collected using questionnaire-led interviews and clinical examinations. The questionnaire consisted of a validated questionnaire of the Persian version of the OIDP index, sociodemographic characteristics and self-reported general and oral health of subjects. The number of teeth, prosthetic status and the decayed, missing and filled tooth score (DMFT) were recorded according to WHO criteria. Statistical analyses were performed by Wilcoxon test and linear regression modeling. Results: A total of 499 individuals participated in the study. Among the subjects, 82.6% had experienced one or more oral impacts on their daily activities, and 49.5% of impacts were reported to be of severe or very severe intensity. Eating was the performance most frequently affected (50.1%) followed by smiling (16.2%) and sleeping (11.8%). The OIDP score was higher in the participants with a lower wealth index (P = 0.015) and in those with more decayed teeth (P = 0.013). The association between self-reported oral health and OIDP score was of borderline significance (P = 0.05). Conclusion: Oral health status has an enormous impact on the daily performance of Iranian adults attending the dental care center. More emphasis on oral health care in disadvantaged populations, particularly in countries with a developing oral health system, is required. [ABSTRACT FROM AUTHOR]

Purpose: To determine changes in oral health behaviour following low-cost oral health education among mother-child pairs. Materials and Methods: In this controlled trial, interviews were conducted in a random sample of mothers of 12- to 15-month-olds (N = 242) attending the vaccination offices of public health centres in Tehran, Iran, and the vaccination staff provided oral health education for the mothers belonging to two intervention groups (A and B) and a control. Groups A and B received health education, but group A additionally received two reminders during the 6-month follow-up. The control group received no health education. The mothers' oral health behaviour and practices with regard to their children were scored at baseline and at the end. Changes in these scores were recorded separately for the mothers and the children and grouped into the categories prominent, minor or no improvement. Statistical evaluation was performed with the chi-square test, ANOVA and logistic regression. Results: Prominent improvement in oral health behaviour was evident in 45% of the mothers and 66% of the children in group A, 29% of the mothers and 31% of the children in group B and in 11% of the mothers and 21% of the children in the control group (P < 0.001). A prominent improvement in the mothers' practices with regard to their children was related to the mother's own behavioural improvement (OR = 1.3). The intervention was most successful in group A (OR = 5.1). Conclusion: Improvement in mothers' oral health behaviour can lead to improved health practices with regard to their children. Oral health education combined with external motivation is a valuable tool for promoting oral health behaviour in mother-child pairs. [ABSTRACT FROM AUTHOR]

Background: Universal health care (UHC) may assist families whose children are most prone to early childhood caries (ECC) in accessing dental treatment and prevention. The purpose of this study was to determine the association between UHC, health expenditure and the global prevalence of ECC. Methods: Health expenditure as percentage of gross domestic product, UHC service coverage index, and the percentage of 3–5-year-old children with ECC were compared among countries with various income levels using one-way analysis of variance (ANOVA). Three linear regression models were developed, and each was adjusted for the country income level with the prevalence of ECC in 3–5-year-old children being the dependent variable. In model 1, UHC service coverage index was the independent variable whereas in model 2, the independent variable was the health expenditure as percentage of GDP. Model 3 included both independent variables together. Regression coefficients (B), 95% confidence intervals (CIs), P values, and partial eta squared (ƞ2) as measure of effect size were calculated. Results: Linear regression including both independent factors revealed that health expenditure as percentage of GDP (P < 0.0001) was significantly associated with the percentage of ECC in 3–5-year-old children while UHC service coverage index was not significantly associated with the prevalence of ECC (P = 0.05). Every 1% increase in GDP allocated to health expenditure was associated with a 3.7% lower percentage of children with ECC (B = − 3.71, 95% CI: − 5.51, − 1.91). UHC service coverage index was not associated with the percentage of children with ECC (B = 0.61, 95% CI: − 0.01, 1.23). The impact of health expenditure on the prevalence of ECC was stronger than that of UHC coverage on the prevalence of ECC (ƞ2 = 0.18 vs. 0.05). Conclusions: Higher expenditure on health care may be associated with lower prevalence of ECC and may be a more viable approach to reducing early childhood oral health disparities than UHC alone. The findings suggest that currently, UHC is weakly associated with lower global prevalence of ECC. [ABSTRACT FROM AUTHOR]

Background: This study assessed the direct, indirect and total effect of distal – political - risk indicators (affecting populations), and proximal risk indicators (affecting women) on the global prevalence of early childhood caries (ECC) in 3–5 year old children. Methods: Data on global ECC prevalence were obtained from a prior study. Data for distal risk indicators (voice and accountability; political stability/absence of terrorism; control of corruption) were obtained from the World Bank Governance indicators, 2016. Data for proximal risk indicators (women's opportunity for leadership; percentage of female legislators, top officials and managers; basic employability status of women; ability of women to afford time off work to care for newborns; gross national income (GNI) per capita for females) were derived from the Human Development Index, 2016. Associations between variables were assessed with path analysis. Results: Voice and accountability (β = − 0.60) and GNI per capita for females (β = − 0.33) were directly associated with a lower ECC prevalence. Political stability/absence of terrorism (β =0.40) and higher percentage of female legislators, senior officials and managers (β = 0.18) were directly associated with a higher ECC prevalence. Control of corruption (β = − 0.23) was indirectly associated with a lower ECC prevalence. Voice and accountability (β = 0.12) was indirectly associated with a higher ECC prevalence. Overall, voice and accountability (β = − 0.49), political stability/absence of terrorism (β = 0.34) and higher female GNI (β = − 0.33) had the greatest effects on ECC prevalence. Conclusion: Distal risk indicators may have a stronger impact on ECC prevalence than do proximal risk indicators.. Approaches to control ECC may need to include political reforms. [ABSTRACT FROM AUTHOR]

Background Given that one of the targets of Global oral health care goals in 2020 is to increase the proportion of the population covered by health care information systems, the future dentists should be more oriented about Information Technology (IT) to help the health systems in reaching this goal. The aim of this study was to evaluate the utilization of IT among senior dental students and to evaluate the association of self-reported skills with utilization of IT. Methods The target population comprised senior dental students of all four dental schools of Tehran City in 2015. An anonymous selfadministered questionnaire queried their utilization of IT in four areas: general use of computers, general use of internet, professional use of computers, and professional use of internet. In addition, the students self-reported IT skill was obtained in two areas: internet searching skills and computer using skills. Background questions were also asked. Results Totally, 218 questionnaires out of 250 were returned for an overall response rate of 85%. The students' mean score for professional usage of computer was 15.3 (± 4.2) out of 30 and for professional usage of internet 10.8 (± 3.1) out of 20. The mean score for general usage of computers was 22.6 (± 5.4) out of 40 and for general usage of internet 46.1 (± 13.2) of 80. About computer skills, a mean of 18.6 (±4) out of 28 and internet searching skills a mean of 15.3 (±4) out of 24 was acquired. The linear regression model revealed that older student (regression coefficients = 0.325, P = 0.001) and those with higher computer using skills (regression coefficients = 0.223, P = 0.031) and internet searching skills (regression coefficients = 0.220, P = 0.027) obtained higher scores in general usage of IT. Also higher research experience gained was associated with higher scores in professional usage of IT (regression coefficients = -0.378, P =0.02). Conclusion IT utilization and skills were not desirable in present students. The fact that IT skills were associated with a higher IT utilization regardless of other background factors casts light on the importance of training to facilitate full utilization. [ABSTRACT FROM AUTHOR]

An amendment to this paper has been published and can be accessed via the original article. [ABSTRACT FROM AUTHOR]