Transcript oral health education

Health Education
of School-Aged Children
Suzanne Marks, Director
Albuquerque Area Dental
Support Center
Overview
The effectiveness of oral health education
Factors that help or hinder health messaging
Resources that are readily available to support your
efforts to educate your patients
“A rose by any other name
...“
• Health education
• Anticipatory
guidance
• Health
communication
all refer to some
aspect of the process
of informing and
influencing individual
and/or community
decisions intended to
enhance health
Health education can . . .
• Increase the intended audience’s
knowledge and awareness of a health
issue, problem or solution
• Influence perceptions, beliefs or
attitudes that may change social norms
• Prompt action
• Demonstrate or illustrate healthy skills
Health education can also . . .
• Reinforce knowledge, attitudes or behavior
• Show the benefit of behavior change
• Advocate a position on a health issue or
policy
• Increase demand or support for health
services
• Refute myths or misconceptions
Health Education (by itself) cannot . . .
• Compensate for inadequate health care or access to
health care services
• Produce sustained change in complex health
behaviors without the support of a larger program for
change
• Be equally effective in addressing all issues or
relaying all messages
Is health education
effective as a preventive
strategy?
Efficacy of an oral health promotion
intervention in the prevention of early
childhood caries
• In a 2008 Australian study, Plutzer and Spencer
tested the efficacy of an oral health promotion
intervention in the prevention of ECC
• Conclusion: an oral health promotion programme
based on repeated rounds of anticipatory
guidance initiated during the mother’s pregnancy
was successful in reducing the incidence of ECC in
very young children.
Oral health promotion for
schoolchildren
• In a 2007 study Livny et al. evaluated the effect of a
pragmatic education program on tooth brushing skills
among young schoolchildren
• Conclusion: behavioral instruction emphasizing
improvement of personal manual skills
successfully increased the average number of dental
areas brushed
The Effectiveness of Evidence-Based
Oral Hygiene Advice and Instruction
Upon Patient Oral Hygiene
• In a 2006 randomized controlled trial, Clarkson et al.
evaluated the effectiveness of providing evidence
based oral hygiene advice and instruction
• Patients who received the evidence based oral
hygiene advice and instruction were significantly
more confident about their ability to toothbrush
effectively and had significantly less plaque and
gingival bleeding
Are these studies as revolutionary as
those demonstrating the impact of
community water fluoridation?
Probably not
Are these studies as compelling as those
demonstrating the efficacy of fluoride
varnish?
Doubtful
Cochran Database of
Systematic Reviews
A recent Cochrane review looked at
school-based interventions aimed at
changing behavior related to tooth
brushing habits and the frequency of
consumption of cariogenic food and drink
in children between the ages of 4 and 12
years.
• Randomized or cluster randomized
controlled trials were included.
• Studies had to include behavioral
interventions addressing both tooth brushing
and consumption of cariogenic foods or
drinks and have a primary school as a focus
for delivery of the intervention.
• The primary outcomes were changes in
caries or plaque levels.
4 studies were reviewed
involving 2,302 children . . .
1 study was at unclear risk of bias and 3
were at high risk of bias.
Only 1 small study
. . . with an unclear risk of bias, reported
on caries. This found a prevented fraction
of 0.65 in the intervention group.
3 studies found less
plaque . . .
in children receiving the program but they
were not combined in a meta-analysis
due to differences in study designs and in
the details of the interventions.
Secondary outcome measures from one
study reported that the intervention had a
positive impact upon children’s oral
health knowledge.
The reviewers concluded
• Currently, there is insufficient evidence
for the efficacy of primary school-based
behavioral interventions for reducing
caries.
• There is limited evidence for the
effectiveness of these interventions on
plaque outcomes and on children’s oral
health knowledge acquisition.
.
• None of the included interventions were
reported as being based on or derived
from behavioral theory.
• There is a need for further high quality
research utilizing theory in the design
and evaluation of interventions for
changing oral health related behaviors
in children and their parents
Does health education still
have a place in the
comprehensive prevention
and treatment of oral disease?
ABSOLUTELY!!
American Dental Association
ADA announced another new initiative, Action
for Dental Health, designed to reduce the
numbers of adults and children with untreated
dental disease through ORAL HEALTH
EDUCATION, prevention and treatment for
those in need
The American Academy of
Pediatric Dentistry
“Appropriate discussion and counseling
should be an integral part of each visit.”
American Academy of
Pediatrics
“Oral health anticipatory guidance can
reduce dental expenditures. In light of this
evidence, oral health anticipatory
guidance should be integrated as a part
of comprehensive counseling during wellchild visits.”
American Academy of
Nurse Practitioners
“The importance of . . . anticipatory
guidance during well-child care visits
cannot be overestimated.”
Factors affecting health
communications
Factors that are likely outside
the provider’s control
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Poverty
Socioeconomic status
Geography
Education levels
Factors that can be
accommodated by the
provider
• Influence of culture and family
• Developmental learning stages
• Health literacy
The Influence of Culture
Is there a difference?
The Ortegas
The Tsosies
How might culture express itself in
health communications between
provider and Native patient?
May be more likely to regard
concepts holistically and
visually/symbolically
How might culture express itself in
health communications between
provider and Native patient?
May be more likely to
value "wait" time
How might culture express itself in
health communications between
provider and Native patient?
May be more likely to observe
before acting or questioning
How might culture express itself in
health communications between
provider and Native patient?
May be more likely to speak
softly
How might culture express itself in
health communications between
provider and Native patient?
May be more likely to avoid
eye contact out of respect
The influence of family
Who should we be educating?
Research indicates . . .
Mother’s perceptions
influence their children’s
oral hygiene practices
At least initially . . .
Oral hygiene is the
responsibility of the
parent
As the child develops
home care will
likely be performed
jointly by parent
and child.
School Age Children
Begin to
demonstrate the
understanding
and ability to
perform personal
hygiene
techniques
independently.
The Influence of
Developmental Learning
Stages
The School Age Child
• Physical development is relatively
problem free making it easy to master
new skills
• Most children are able to think logically
provided the topic is not too abstract
• Eager to learn: enthusiastic,
perseverant and curious
The School Age Child
• Can clearly
distinguish right and
wrong
• Still believes their
parents are helpful,
their teachers are
fair and their friends
are loyal
Oral Health Education Topics for
School-Age Children and their
Families
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Changes in the teeth and the mouth
Oral hygiene practices (frequency, problems)
Use of fluoridated water for drinking or cooking
Fluoride use (fluoridated toothpaste, fluoride supplements)
Dental sealant use
Eating practices
Non-nutritive sucking (pacifier, thumb, finger)
Illnesses or infections
Medications
Physical activity and sport participation
Injuries to the teeth or the mouth
Use of tobacco by parents or child
Adolescents
• The transition from child- to adulthood
• The most challenging and complicated
period of life
• Biological changes are universal but
their expression, timing and extent is
extremely variable
Adolescents
• Cognitive development varies as well
from egocentric to logical, hypothetical
and theoretical
• Adjusting to changing body sizes,
shapes and feelings
Oral Health Education Topics for
Adolescents and their Families
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Changes in the teeth or the mouth
Oral hygiene practices (frequency, problems)
Use of fluoridated water for drinking or cooking
Fluoride use (fluoridated toothpaste, fluoride supplements)
Dental sealant use
Eating practices
Illnesses or infections
Medications
Physical activity and sports participation
Injuries to the teeth or the mouth
Use of tobacco by adolescent
The Influence of Health
Literacy
Health Literacy
“is the degree to which individuals have
the capacity to obtain, process, and
understand basic health information and
services needed to make appropriate
health decisions.”
Who’s responsible for
improving health literacy?
We are!!
The primary responsibility for improving
health literacy lies with public health
professionals and the healthcare and
public health systems.
What’s a provider to do?
Instead of “eat nutritious
foods,”
Use
simple
words
Use “snack on fruits and
vegetables”
Instead of “assist your child”
Use “help”
What’s a provider to do?
Instead of
Use an
active
voice
“your teeth should be brushed
at least twice a day”
Use
“brush your teeth in the
morning and before bed”
What’s a provider to do?
Instead of
Use a
positive
tone
“you shouldn’t drink soda”
Use
“save soda for a special treat
or drink water”
What’s a provider to do?
Instead of
Use
concrete
words &
examples
“good oral health care is
important to the health of teeth
and gums”
Use
“brushing twice a day with
fluoride toothpaste can help
your teeth stay healthy”
Help your patients build
their health literacy skills
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Use simple words
Use an active voice
Use a positive tone
Use concrete words and examples
Increasing the effectiveness
of health education
Through the dental home
Characteristics of Effective
Health Education
• Teaches functional health information
(essential knowledge)
• Shapes personal values and beliefs that
support healthy behaviors
• Shapes group norms that value a healthy
lifestyle
• Develops the essential health skills
necessary to adopt, practice and maintain
health enhancing behaviors
The Ace in your hand?
Through the Dental Home!!
Definition of Dental Home
“The dental home is the ongoing
relationship between the dentist and the
patient, inclusive of all aspects of oral
health care delivered in a comprehensive,
continuously accessible, coordinated, and
family center way.”
Bright Futures Guidelines for
Health Supervision of Infants,
Children and Adolescents
“Having a dental home is the ideal
deterrence to the development of caries,
from infancy through adolescence.”
The Dental Home is an
ongoing relationship
•Organize health education so the most
important points come first
•Break complex information into
understandable chunks
•Deliver repeated rounds of anticipatory
guidance
•Emphasize (and re-emphasize) personal
manual skills
•Educate the patient and family while
accommodating their cultural differences
•And help to build their health literacy
skills
Resources to support
clinical oral health
education efforts
Bright Futures in Practice: Oral Health—
Pocket Guide
The National Maternal & Child
Oral Health Resource Center
www.mchoralhealth.org
Albuquerque Area Dental
Support Center
In summary . . .
The effectiveness of oral health education
Factors that help or hinder health messaging
Resources that are readily available to support your
efforts to educate your patients
“You cannot educate a child who
is not healthy and you cannot
keep a child healthy who is not
educated”
Jocelyn Elders
Former US Surgeon General