| 1. |
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| 2. |
- Lexomboon, Duangjai, 1965-, et al.
(författare)
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Chewing ability and tooth loss : association with cognitive impairment in an elderly population study
- 2012
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Ingår i: Journal of The American Geriatrics Society. - : Wiley. - 0002-8614 .- 1532-5415. ; 60:10, s. 1951-1956
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To determine whether there is an association between tooth loss, chewing ability, and cognitive function in a general elderly population.DESIGN: Data from the Panel Study of Living Conditions of the Oldest Old in 2002 were analyzed. Stepwise logistic regression analyses were used to examine the relationship between cognitive function and tooth loss and chewing ability.PARTICIPANTS: Five hundred fifty-seven persons who were nationally representative of the Swedish population aged 77 and older.MEASUREMENTS: Cognitive function was measured using the abridged version of the Mini-Mental State Examination. Information on dental status and chewing difficulty was obtained according to self-assessment.RESULTS: Persons with multiple tooth loss and persons with difficulty chewing hard food had significantly higher odds of cognitive impairment. When adjusted for sex, age, and education, the odds of cognitive impairment were not significantly different between persons with natural teeth and with multiple tooth loss, but the odds of impairment remained significantly higher for persons with chewing difficulty even when adjusted for sex, age, education, depression, and mental illness.CONCLUSION: Sex, age, education, and certain illnesses do not explain the association between cognition and chewing ability. Whether elderly persons chew with natural teeth or prostheses may not contribute significantly to cognitive impairment as long as they have no chewing difficulty. The results add to the evidence of the association between chewing ability and cognitive impairment in elderly persons.
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| 3. |
- Lexomboon, Duangjai, 1965-, et al.
(författare)
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Consumption and direct costs of dental care for patients with head and neck cancer : A 16-year cohort study
- 2017
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Ingår i: PLOS ONE. - : PUBLIC LIBRARY SCIENCE. - 1932-6203. ; 12:8
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Tidskriftsartikel (refereegranskat)abstract
- Patients with head and neck (H&N) cancer are commonly treated with surgery and/or radiotherapy, which can increase the risk of oral infection, dental caries, and periodontal disease. The present study investigated dental care consumption and costs in patient with H&N cancer before and after the cancer diagnosis. Data from Swedish regional and national registers were used to follow up dental care utilization and dental procedure costs. The analysis included 2,754 patients who had been diagnosed with H&N cancer (exposed cohort) in Stockholm County, Sweden, during 2000–2012 and 13,036 matched persons without cancer (unexposed cohort). The exposed cohort was sub-grouped into irradiated and non-irradiated patients for analysis. The exposed cohort underwent a moderately higher number of dental procedures per year than the unexposed cohort in both the year of the cancer diagnosis and the year after cancer diagnosis; in addition, these numbers were higher in the irradiated than in the non-irradiated subgroup of the exposed cohort. Dental care consumption and costs in the exposed cohort declined over time but remained at a slightly higher level than in the unexposed cohort over the long term (more than two years). Examinations and preventive procedures accounted for most of the higher consumption in the short term (2 years) and at the longer term follow-up. Swedish national insurance subsidized costs for dental treatment, which were highest in the irradiated subgroup and lowest in the unexposed cohort. Direct costs to the patient, however, were similar among the groups. Swedish national health insurance protects patients with H&N cancer from high dental expenditures. Further studies on the cost-effectiveness of preventive dental care for patients are needed.
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| 4. |
- Lexomboon, Duangjai, 1965-, et al.
(författare)
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Determinants of tooth loss and chewing ability in mid- and late life in three Swedish birth cohorts
- 2015
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Ingår i: Ageing & Society. - 0144-686X .- 1469-1779. ; 35:5, s. 1304-1317
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the research presented is to determine the influence of socio-economic factors in childhood and mid-life on multiple tooth loss and chewing problems in mid- and late life in three Swedish birth cohorts (1903–1910, 1911–1920 and 1921–1925). Longitudinal national Swedish surveys were used for the analysis. Participants were interviewed in mid-life in 1968 and later in life (77–99 years of age) in 2002. Childhood socio-economic positions (SEP) did not result in different odds of multiple tooth loss and chewing problems in mid- and late life, but persons with higher mid-life SEP had lower odds. Persons born into the 1921–1925 birth cohort had significantly lower odds of multiple tooth loss in late life than the 1903–1910 birth cohort. Women had higher odds of losing multiple teeth than men in late life but not mid-life. Neither gender nor childhood and mid-life SEP predicted chewing problems late in life, but older people with multiple tooth loss had higher odds of chewing difficulty than those with mainly natural teeth. Childhood conditions may contribute to multiple tooth loss in mid-life, which subsequently contributes to multiple tooth loss in late life. Tooth loss in late life is strongly associated with difficulty chewing hard food. Prevalence of multiple tooth loss is higher in women than in men in late life but not in mid-life.
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| 5. |
- Lexomboon, Duangjai, et al.
(författare)
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Incidence and causes of dental trauma in children living in the county of Varmland, Sweden
- 2016
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Ingår i: Dental Traumatology. - : Wiley. - 1600-4469 .- 1600-9657. ; 32:1, s. 58-64
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Tidskriftsartikel (refereegranskat)abstract
- AimThe aims of this study were to determine the incidence of injuries to permanent incisors in 2011-2013 in children aged 8-10years living in the county of Varmland, Sweden, and to compare it with the incidence rates in 1989/1990 in the county of Vastmanland, as well as to determine the cause of dental trauma in relation to time and place. MethodThe study analysed the patient records from dental visits (2011-2013) of trauma to the permanent incisors in children aged 8-10years. The incidence rates were the incidence per 1000 children at risk. Standardized incidence rates were calculated for the comparison between different years. Information about month, location where the trauma occurred as well as cause of trauma was recorded. ResultsA total of 2.2% of 21721 children aged 8-10years had experienced at least one trauma. The incidence rate in Varmland increased from 18.9 in 2011 to 21.3 in 2012 to 28.5 in 2013. The standardized incidence rate in Varmland in 2011 and 2012 was not significantly different than in Vastmanland in 1989/1990 (P>0.05), but the standardized rates in 2013 were significantly higher than in 1989/90 (P<0.001). Dental trauma occurred most often outdoors, followed by sports arenas/sports fields, and more often at school than at home. Falling and slipping was the most common cause of trauma, followed by accidents during leisure activities, playing and sports. ConclusionThe incidence rate for dental trauma has not decreased in the past 20years, and there is an indication that parents and teachers should be more aware of the risks of dental trauma at leisure times and at school as well as during sports and exercise.
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| 6. |
- Lexomboon, Duangjai, 1965-, et al.
(författare)
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Supply projections for dentists, Thailand (2000-2030).
- 2000
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Ingår i: Human Resource for Health Development Journal. ; 4:2, s. 94-105
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Tidskriftsartikel (refereegranskat)abstract
- Abstract In the1970s, dental manpower in Thailand was found to be in short supply. In responseto this shortage, both the Ministry of University Affairs (MoUA) and the Office of NationalEducation Council (ONEC) proposed production plans to expand the supply of dentists. As aconsequence, the production of dentists has been increasing dramatically over the past 20 years.Experience from many countries has shown that such a rapid expansion of supply for dentists, ifnot periodically evaluated, could lead to a state of oversupply. This paper projects the supply of dentists in Thailand for the next 30 years, using theproposed first year enrollment plans of MoUA and ONEC, in order to compare future supplywith the projected requirements. WHO models for projecting workforce supply andrequirements and cohort retention rate method were used in this study. The student dropout rateused in this study was found to be approximately 2%, equal to the one used in MoUA plan.Estimated quinquennial retention rates for the dental workforce declined from 99% to 75% overthe first 34 years following completion of training, with a maximum working life of 50 years. The supply projections for dentists under the production plans of MoUA and the ONECshow that the population per dentist will decrease from 10,350 in the year 2000 to 6,072 and to3,082 in 2030. The MoUA production plan projects a supply similar to the projectedrequirement in the next 15 years but the ONEC production plan projects an oversupply state.The current economic crisis of the country coupled with health care reform, support anincreased emphasis of preventive care, which can be effectively rendered by dental nurses.Future production planning, therefore, should take into consideration the future use of auxiliarypersonnel and changes in dental health care provision.
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| 7. |
- Lexomboon, Duangjai, et al.
(författare)
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The community-based oral health promotion in a rural area, Thailand
- 2013
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Ingår i: Effective Integration of Oral Health into Health Systems.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: The dental caries in preschool children living in underserved remote rural areas in Thailand is a dental public health problem. The limited access to dental care contributes to the significance of an effective oral health promotion program that based on resources available in these areas. Objectives: To reduce dental caries rate and risk behaviours in pre-school children as well as to increase oral care knowledge and attitude of child-caretakers living in underserved rural areas. Method: A pilot community-based oral health promotion program was launched in Srimongkol Sub-district, Kanchanaburi Province. The program included tooth brushing after lunch, limited cariogenic snacking during school time, oral health educational games, fluoride varnish application every six months by dental nurses in school setting, and mass media oral health campaign in the village. Results: A three-year evaluation compared caries experiences of 40 children at year-three in a childcare center at the evaluation year (Program group, PG) with 18 children at year-three at the beginning of the program (Control group, CG). The PG children were slightly older than the CG children (73.6±7.6 vs. 69.4±4.1 months; p<.05). The dmft of the PG children was 8.8±4.3, significantly lower than 12.1±4.4 of the CG children (p<.01). However, the new caries rate was 3.0±2.6 teeth in three years. Of the PG children, the percentages of parents who had increased knowledge on child oral care were 64.3 – 90.9%, the percentage who thought that primary teeth were important increased 55.6%, and the percentage who believed that he/she could prevent caries in his/her child increased 20.0%. Conclusion: Children who joined the program had significantly lower caries experience compared to the control group and the parents had better knowledge and attitude about child oral care at evaluation year. A controlled field study with larger number of children and a cost-effectiveness study are indicated.
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| 8. |
- Lexomboon, Duangjai, 1965-, et al.
(författare)
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The community radio program in a rural area, Thailand
- 2009
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Ingår i: Community Participation and Global Alliances for Lifelong Oral Health for All.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Objective: To assess whether a public educational program can increaseknowledge and attitude related to oral health, as well as self carebehavior among remote rural area people in Thailand. Methods: Aninterviewed questionnaire was used to measure attitude, knowledge, andself-care practice at pre- and post-intervention among people living inBan Nayao Village, Sanamchaiket District, Chachengsao Province. Twohouseholds from each 34 blocks were selected in a systematic manner. The program used community radio broadcasting as the main educationalmedia and posters as supplements. One out of 57 messages, each 2-4minutes long, was broadcast at the beginning of each hour from8.00-19.00. Fifty posters were placed in the community gathering areassuch as market, shops, and restaurants. The posters were replaced withnew ones after two months in display. Results: The pre-interventionassessment showed that 71.1% of 154 persons, age 16 ? 89 years old,listened to this radio frequency regularly. At four months, 133 personswere available for the evaluation. Among these persons, 81.7% hadincrease knowledge score, and the mean score increased significantlyfrom 8.6±3.7 to 10.8±4.2 (p = 0.000). For attitude toward self-care,there was no significant change in belief in own ability to preventfurther dental caries and tooth lose. For self-care behavior, thepercentage of dentate persons brushing before bedtime increasedsignificantly from 70.0% to 76.8% (p = 0.000). Among four denturewearers, one wore them at night and brushed them in the mouth atpre-intervention and still did the same at post-intervention. Threebrushed dentures with water at pre-intervention, but one of these threebrushed them with toothpaste at post-intervention. Conclusion: Thepublic educational program showed initial increases in dental knowledgebut not attitude for self-care. Self-care practice improved amongdentate persons but not among denture wearers.
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| 9. |
- Lexomboon, Duangjai, 1965-, et al.
(författare)
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The Effect of Xerostomic Medication on Oral Health in Persons With Dementia
- 2018
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Ingår i: Journal of the American Medical Directors Association. - : Elsevier. - 1525-8610 .- 1538-9375. ; 19:12, s. 1080-1085
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Medication-induced hyposalivation can increase the risk for oral complications, including dental caries and tooth loss. This problem is particularly important in people with dementia because of their declining ability to maintain oral care. The objective of this study was to describe the association between the number of xerostomic medications used and tooth loss and restorative and dental preventive treatment in a population of persons with dementia. Design: A longitudinal population-based register study with a 3-year follow-up was conducted. Data were extracted from the Swedish Dementia Registry (SveDem), the Swedish Prescribed Drug Register (SPDR), the Swedish National Patient Register (SNPR), and the Dental Health Register (DHR). Setting and participants: Participants were persons with dementia who were registered in the SveDem at the time of their dementia diagnosis. Measures: The exposure was continuous use of xerostomic medications over the 3 years prior to dementia diagnosis (baseline). The outcomes were the incidence of tooth extractions, tooth restorations, and dental preventive procedures. Poisson regression models were used to estimate incidence rate ratios (IRRs) for the association between the exposure and outcomes, adjusting for relevant confounders. Results: A total of 34,037 persons were included in the analysis. A dose-response relationship between the exposure and tooth extractions was observed. Compared with nonusers of xerostomic medication, the rate of tooth extractions increased with increasing number of xerostomic medications used (IRR = 1.03, 1.11, and 1.40 for persons using an average >0-1, >1-3, and >3 xerostomic medications, respectively). However, the risk for having new dental restorations and receiving preventive procedures did not differ between groups. Conclusion: Continuous use of xerostomic medications can increase the risk for tooth extraction in people with dementia. This study highlights the importance of careful consideration when prescribing xerostomic medications to people with dementia, and the need for regular and ongoing dental care.
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| 10. |
- Lexomboon, Duangjai
(författare)
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The oral health of the elderly; yesterday, today and tomorrow
- 2014
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Ingår i: Age Well.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Oral health of elderly person has many close links to general health and wellbeing. Periodontal disease is associated with various diseases such as diabetes, cardiovascular diseases, and stroke. Common oral health conditions among the elderly population, such as xerostomia/hyposalivation, difficulty in swallowing, yeast infection, poor taste sensation, and poor chewing ability, can lead to poor quality of life. Epidemiological data show higher proportion of Swedish elderly persons maintains their natural teeth in their old age. The Swedish population surveys report the proportion of persons aged 65-76 years being edentulous has decreased from higher than 80% in 1968 to lower than 30% in 2002. The 34-year longitudinal data analysis shows that persons who were born in more recent birth cohort had lower risk of tooth loss and chewing difficulty at old age.The analysis also shows that childhood social position, an indicator for risk and protective factors, increases risk for multiple tooth loss at midlife and also are associated with social position at midlife. Social position at midlife contributes to multiple tooth loss at old age, which subsequently increases risk for difficulty chewing hard food. Additional data analysis also shows that chewing difficulty increases risk for cognitive impairment.The longitudinal data analysis also shows that prevalence of multiple tooth loss is higher in women than in men at old age but not in midlife, while there is no gender different in chewing difficulty neither at midlife nor at old age.While elderly persons tend to maintain their teeth at old age, it becomes great important that they also maintain good oral hygiene since poor oral hygiene can increase risk for periodontal diseases and aspiration pneumonia. Special attention should also be given to prevent tooth loss in women in mid-to-late life.
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| 11. |
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| 12. |
- Punyasingh, Komson, et al.
(författare)
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Baseline projection of requirements for dental health manpower in Thailand (1995-2015 AD.)
- 1997
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Ingår i: Human Resource for Health Development Journal. ; 1:1, s. 24-34
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Tidskriftsartikel (refereegranskat)abstract
- This study is intended to compare the dental health personnel supply to the requirement in each 5-year interval from 1995 to 2015. The dental health personnel supply was calculated by subtracting the annual personnel loss from the current active personnel plus the annual personnel production. The results show that there will be 10,100 dentists and 7,718 dental nurses in supply in the year 2015. The personnel requirement was calculated using 3 different techniques; the population ratio technique, the FDI/WHO technique, and the system dynamics technique. The dental personnel to population ratio of 1:5,000 was used to calculate the personnel requirement in the population ratio technique. The FDI/WHO and the system dynamics techniques calculated the personnel requirement by converting the need for service into the need for personnel. While the FDI/WHO technique calculated the need for service based on the lifetime of care for each age cohort, the system dynamics technique calculated the need for service which changed with the alternations in the input factors such as the socioeconomics of the population, the trend of oral diseases, and the structure of health care system. From these three techniques, the requirement for dentists ranges from 8,920 to 9,748 and for dental nurses ranges from 3,046 to 10,974. The results show that in the year 2015, the supply of dentists exceeds the requirement regardless of what technique is used. Similarly, the supply of dental nurses is higher than the requirement when the calculations are done using the population ratio technique and the system dynamics technique. However, the dental nurses will be in shortage according to the FDI/WHO technique. The reason for this different outcome is that dental nurses in the FDI/WHO technique provide health promotion and health education services as well as preventive and simple curative services; while in the other two techniques they provide only preventive and simple curative treatment.
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| 13. |
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| 14. |
- Tan, Edwin C. K., et al.
(författare)
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Medications That Cause Dry Mouth As an Adverse Effect in Older People : A Systematic Review and Metaanalysis
- 2018
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Ingår i: Journal of The American Geriatrics Society. - : Wiley. - 0002-8614 .- 1532-5415. ; 66:1, s. 76-84
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Forskningsöversikt (refereegranskat)abstract
- OBJECTIVES: To assess and quantify the risk of drug-induced dry mouth as a side effect in older people.DESIGN: Systematic review and metaanalysis.SETTING: A search of the literature was undertaken using Medline, Embase, Cochrane, Web of Science, and PubMed from 1990 to 2016.PARTICIPANTS: Older people (aged 60) who participated in intervention or observational studies investigating drug use as an exposure and xerostomia or salivary gland hypofunction as adverse drug outcomes.MEASUREMENTS: Two pairs of authors screened titles and abstracts of studies for relevance. Two authors independently extracted data, including study characteristics, definitions of exposure and outcome, and methodological quality. For the metaanalyses, random-effects models were used for pooling the data and I-2 statistics for exploring heterogeneity.RESULTS: Of 1,544 potentially relevant studies, 52 were deemed eligible for inclusion in the final review and 26 in metaanalyses. The majority of studies were of moderate methodological quality. In the intervention studies, urological medications (odds ratio (OR)=5.91, 95% confidence interval (CI)=4.04-8.63; I-2=62%), antidepressants (OR=4.74, 95% CI=2.69-8.32, I-2=21%), and psycholeptics (OR=2.59, 95% CI=1.79-3.95, I-2=0%) were significantly associated with dry mouth. In the observational studies, numbers of medications and several medication classes were significantly associated with xerostomia and salivary gland hypofunction.CONCLUSION: Medication use was significantly associated with xerostomia and salivary gland hypofunction in older adults. The risk of dry mouth was greatest for drugs used for urinary incontinence. Future research should develop a risk score for medication-induced dry mouth to assist with prescribing and medication management.
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| 15. |
- Tan, Edwin C. K., et al.
(författare)
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Validating a model for medication-related dental outcomes in older people
- 2022
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Ingår i: Oral Diseases. - : Wiley. - 1354-523X .- 1601-0825. ; 28:6, s. 1697-1704
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To externally validate a model for medication-related dental outcomes in (a) a general older population with dementia and (b) a matched population without dementia.Subjects and Methods: This validation study used population-based data from seven Swedish national registers (2008–2017). Individuals aged 60+ with dementia were matched to those without dementia on age, gender, and county of residence at the date of diagnosis (index date). The exposure was continuous use of xerogenic medications during the 3-year period before index date. The primary outcome was the number of tooth extraction and restorative procedures within 3 years after index date.Results: A total of 334,220 individuals were included in the final sample. In the dementia cohort, the use of urological drugs (incidence rate ratio [IRR] 1.08, 95% CI 1.03–1.13), respiratory medicines (IRR 1.10, 95% CI 1.04–1.17), and proton-pump inhibitors (IRR 1.09, 95% CI 1.05–1.13) was associated with the primary outcome. In the non-dementia cohort, respiratory medicines (IRR 1.03, CI 1.00–1.05), proton-pump inhibitors (IRR 1.06, CI 1.04–1.08), opioids (IRR 1.05, CI 1.03–1.07), and antidepressants (IRR 1.06, CI 1.04–1.08) were associated with the primary outcome.Conclusions: Although there were differences in prescription patterns, the model performed similarly in both those with and without dementia.
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| 16. |
- Tan, Edwin C. K., et al.
(författare)
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Xerogenic Medications as a Predictor for Dental Health Intervention in People with Dementia
- 2020
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Ingår i: Journal of Alzheimer's Disease. - 1387-2877 .- 1875-8908. ; 75:4, s. 1263-1271
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Tidskriftsartikel (refereegranskat)abstract
- Background: Older adults with dementia often have poor oral health. Chronic use of xerogenic medications may contribute to adverse dental outcomes.Objective: To investigate the impact of xerogenic medication classes on the predicted risk for dental interventions in people with dementia.Methods: Thiswas a population-based cohort study involving 30,955 individuals registered in the Swedish Dementia Registry (SveDem) from 2008 to 2015. Data were linked with other national registers. The exposure was xerogenic medication classes used in the three years prior to dementia diagnosis (baseline). The primary outcome was the composite of number of tooth extractions and dental restorations over the three-year follow-up period. Secondary outcomes included the number of tooth extractions and number of dental restorations. Poisson regression models were used to estimate the association between the exposure and outcomes. Analyses were adjusted for age, gender, Mini-Mental State Examination, living arrangement, dementia disorder, average number of medications, Charlson’s comorbidity index, number of dental visits, and number of teeth.Results: After adjusting for potential covariates, the use of urological drugs (incidence rate ratio [IRR] 1.16, 95% CI 1.04–1.28), proton pump inhibitors (IRR 1.13, 95% CI 1.04–1.23), and opioids (IRR 1.19, 95% CI 1.06–1.34) were significantly associated with the primary composite outcome.Conclusion: The use of specific classes of xerogenic medications was associated with an increased risk for tooth extractions and restorations in people with dementia. The risks and benefits of xerogenic medications, in the context of oral health, should be carefully assessed in this vulnerable population.
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| 17. |
- Thaweboon, Sroisiri, et al.
(författare)
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Remineralization of enamel subsurface lesions by Xylitol chewing gum containing funoran and calcium hydrogenphosphate
- 2009
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Ingår i: The Southeast Asian journal of tropical medicine and public health. - Bangkok. - 0125-1562. ; 40:2, s. 345-353
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the present study was to determine the remineralization effects of xylitol chewing gum containing funoran and calcium hydrogenphosphate on enamel subsurface lesions in humans. The study was a double-blind, randomized, cross-over design, with 4 types of gum: (1) xylitol gum, (2) xylitol gum containing funoran and calcium hydrogenphosphate, (3) sugar gum, and (4) gum base as a control. Seven subjects were instructed to wear removable lingual appliances, with half-slab insets of human enamel containing demineralized subsurface lesions. They were told to chew gum for 20 minutes 4 times per day for 7 days. Upon completion of each treatment the enamel half-slabs were paired with their respective demineralized control half-slabs, embedded, sectioned, and subjected to microradiography and densitometric image analysis, for measurement of the level of remineralization. The mean area of remineralization (ΔZd-ΔZr) and mean percent remineralization (%R) in those chewing xylitol gum containing funoran and calcium hydrogenphosphate were significantly higher than the corresponding values for xylitol gum, sugar gum and gum base. Chewing xylitol gum containing funoran and calcium hydrogenphosphate has a significant effect on the remineralization of initial caries-like lesions of the teeth.
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| 18. |
- Vichayanrat, Tippanart, et al.
(författare)
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The evaluation of a multi-level oral health intervention to improve oral health practices among caregivers of preschool children
- 2012
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Ingår i: Southeast Asian Journal of Tropical Medicine and Public Health. - 0125-1562. ; 43:2, s. 526-539
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Tidskriftsartikel (refereegranskat)abstract
- This study reports the effects of a pilot multi-level oral health interventionon caregivers’ oral health practices and their determinants. Quasi-experimental,pretest-posttest evaluations using a comparison group design were employedto evaluate the effectiveness of a proposed intervention for promoting caregiveroral health behavior. The intervention consisted of three components: home visitsby lay health workers (LHWs), enhancing oral health education and services athealth centers, and community mobilization. These components were designedto target factors at intrapersonal, interpersonal, organizational and communitylevels based on a Social Ecological Model (SEM). Four oral health behaviors associatedwith early childhood caries (infant bottle feeding, tooth brushing, snackconsumption and fluoride use), and multi-level determinants were assessed duringpre- and post-tests. The one-year intervention demonstrated a positive effect ontooth brushing, using toothpaste, and fluoride supplements, but did not have asignificant effect on bottle feeding and snack consumption among children. Theintervention also had no effect on dental caries; in fact caries increased in bothcontrol and experimental groups. The caregiver knowledge, attitudes, outcomeexpectations, and self-efficacy towards these behaviors were significantly increasedin the experimental group after intervention. Caregivers in the experimentalgroup received greater social support by LHWs and health center staff than thosein the control group (p<0.001). The program had an impact on integrating oralhealth services at health centers and community participation in children’s oralhealth. These findings confirm multi-level factors influence reported oral healthbehavior, but not outcomes in terms of caries. Process evaluation is needed todetermine actual implementation levels, barriers and suggests for modificationof the program in the future to improve outcomes in terms of caries.
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