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?

Are these studies as compelling as those demonstrating the efficacy of fluoride varnish?

Probably not

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 well-child 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

• 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.

Begin to demonstrate the understanding and ability to perform personal hygiene techniques independently.

School Age Children

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• 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

• 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 “snack on fruits and vegetables”

Instead of “assist your child”

Use “help”

Use simple words

What’s a provider to do?Instead of

“your teeth should be brushed at least twice a day”

Use

“brush your teeth in the morning and before bed”

Use an active voice

What’s a provider to do?

Instead of

“you shouldn’t drink soda”

Use

“save soda for a special treat or drink water”

Use a positive

tone

What’s a provider to do?Instead of

“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”

Use concrete words &

examples

Help your patients build their health literacy skills

• 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